Avoidance of Coronary Sinus Injury During Retrograde Cardioplegia

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Avoidance of Coronary Sinus Injury During Retrograde Cardioplegia Kazumasa Orihashi, MD, Kohei Miyashita, MD, Miwa Tashiro, MD, Kazuki Kihara, MD, Nobuo Kondo, MD, Masaki Yamamoto, MD, Nobuyuki Hirose, MD, Takashi Fukutomi, MD, Hideaki Nishimori, MD The Annals of Thoracic Surgery Volume 102, Issue 6, Pages e583-e586 (December 2016) DOI: 10.1016/j.athoracsur.2016.06.022 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Basic TEE visualization of coronary sinus (CS), middle cardiac vein (MCV), and cannula. (A) Two scanning levels: CS level (level a) and MCV level (level b). (B) TEE view at level a. (C) TEE view at level b. (RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2016 102, e583-e586DOI: (10.1016/j.athoracsur.2016.06.022) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Variation of alignment between coronary sinus (CS) and cannula. (A) CS parallel to the direction of cannula. (B) Malalignment of CS and cannula. The cannula hits the posterior wall of right atrium (RA; black arrow). (C) The cannula is tilted as red arrow but perforated the CS. (D) Perforation in level b. (LA = left atrium; LV = left ventricle; MCV = middle cardiac vein; RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2016 102, e583-e586DOI: (10.1016/j.athoracsur.2016.06.022) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Avoidance of middle cardiac vein (MCV) injury. (A) The cannula is visualized as an acoustic shadow (A-SH) without strong echo. (B) The cannula entered the MCV, which was masked. (C) As the cannula was withdrawn, the MCV reappeared. (D) The cannula tip was advanced to the coronary sinus (CS), which was masked by A-SH. (The arrow in each figure indicates the location of the cannula.) (RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2016 102, e583-e586DOI: (10.1016/j.athoracsur.2016.06.022) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions