From this point, a dose of cold blood retrograde cardioplegia
was administered to the coronary sinus every 15 minutes.
PLSVC with the absence of RSVC occurs in only 10–20% of cases of PLSVC.[sup] In 90% of individuals, the PLSVC drains into the RA via the CS without hemodynamic consequence.[sup], In the remaining cases, it might drain into the left atrium resulting in a right- to left-sided shunt or into the inferior vena cava or hepatic vein.[sup], A PLSVC can cause problems during central venous catheterization (access to the CS can cause hypotension, angina, perforation of the heart, tamponade, and arrest), pacemaker implantation (due to the tortuous course of the electrode, it might be difficult to fix the electrode into position and obtain stable capture), or cardiopulmonary bypass (isolated PLSVC impairs the use of retrograde cardioplegia
From January 2012 we used the modified technique and used both ante grade and retrograde cardioplegia
. Cardiac venting was done through right upper pulmonary vein.
The suspicion for a PLSVC was communicated to the surgical team given the possible implications for retrograde cardioplegia
Hanafy et al., "Retrograde cardioplegia
does not adequately perfuse the right ventricle," The Journal of Thoracic and Cardiovascular Surgery, vol.
Tight stenosis in the native coronary arteries limits the delivery of antegrade cardioplegia solution distal to critical lesions and hampered myocardial preservation.7,8 Retrograde cardioplegia
through the coronary sinus can be used as additive for myocardium protection during CABG to overcome this limitation of antegrade cardioplegia.
Double arterial cannulation, antegrade and retrograde cardioplegia
, large bore aortic bypass graft, close monitoring, and aggressive control of systemic blood pressure during the case were the keys to our success.
Diagnosis of PLSVC is usually an incidental finding during cardiac surgery for retrograde cardioplegia
, left subclavian vein cannulation for theuropathic or monitoring purposes, device implantation or cardiovascular imaging.
The cardioplegia infusion rates of antegrade and retrograde cardioplegia
were 200 ml/min and 100 ml/min respectively.
14.###Ante and retrograde cardioplegia
n (%)###-###16 (21.1%)
The patient subsequently underwent unroofing of the intramural left coronary artery and suture closure of the patent foramen ovale (PFO) using intraoperative cardiopulmonary bypass and cooling to 30 degrees with retrograde cardioplegia
every 20-30 minutes while the aorta was cross-clamped.