Permyos Ruengsakulrach, Brian F Buxton The Annals of Thoracic Surgery

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Presentation transcript:

Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia Permyos Ruengsakulrach, Brian F Buxton The Annals of Thoracic Surgery Volume 71, Issue 4, Pages 1389-1395 (April 2001) DOI: 10.1016/S0003-4975(00)01991-3

Fig 1 Venous drainage of the heart: (A) anterior view; (B) posterior view. (Adapted from Buxton B, Smith J, Kainer M, Ruengsakulrach P. Basic surgical techniques. In: Buxton B, Frazier OH, Westaby S, eds. Ischemic heart disease surgical management. London: Mosby, 1999:185.) The Annals of Thoracic Surgery 2001 71, 1389-1395DOI: (10.1016/S0003-4975(00)01991-3)

Fig 2 The development of the major thoracic veins: (A) at 7 weeks; (B) full term. (SVC = superior vena cava.) (Adapted from Sadler TW. Langman’s medical embryology. 8th ed. Baltimore: Lippincott, Williams & Wilkins, 2000:249. The Annals of Thoracic Surgery 2001 71, 1389-1395DOI: (10.1016/S0003-4975(00)01991-3)

Fig 3 Persistent left superior vena cava (PLSVC). (A) PLSVC drains through the coronary sinus into the right atrium (RA). The sizes of PLSVC and left brachiocephalic vein are inversely proportional. (B) PLSVC drains into the coronary sinus and a window into the left atrium. (C) PLSVC drains into the left atrium. (D) PLSVC drains into the left pulmonary veins. (SVC = superior vena cava; LV = left ventricle; LA = left atrium; RV = right ventricle; RA = right atrium.) (Adapted from Mantini E, Grondin CM, Lillehei W, Edwards JE. Congenital anomalies involving the coronary sinus. Circulation 1966;33:317–27.) The Annals of Thoracic Surgery 2001 71, 1389-1395DOI: (10.1016/S0003-4975(00)01991-3)

Fig 4 Posterior aspect of the heart. Variations in the distribution pattern of the coronary sinus and venous myocardial drainage: (A) anterior and small cardiac veins enter the right atrium; (B) all major cardiac veins enter the coronary sinus; (C) anterior cardiac veins enter the right atrium; (D) only great cardiac vein and posterior vein of left ventricle enter the coronary sinus; (E) only veins of the lateral wall of left ventricle enter coronary sinus. (Adapted from Ludinghausen [27].) The Annals of Thoracic Surgery 2001 71, 1389-1395DOI: (10.1016/S0003-4975(00)01991-3)

Fig 5 Pathways of retrograde cardioplegia. (Adapted from Wearn JT, Mettier SR, Klumpp TG, Zschiesche LJ. The nature of the vascular communications between the coronary arteries and the chambers of the heart. Am Heart J 1933;9:143–59.) The Annals of Thoracic Surgery 2001 71, 1389-1395DOI: (10.1016/S0003-4975(00)01991-3)