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* From the Department of Anesthesiology (Dr. Langenberg), Jeroen Bosch Ziekenhuis, Hertogenbosch; Departments of Surgery (Drs. Pietersen and Soeters), Thoracic Surgery (Dr. Geskes), and Human Biology (Dr. Wagenmakers), University Hospital Maastricht; and Department of Anesthesiology (Dr. Durieux), University of Maastricht, The Netherlands.
Correspondence to: Chris J. M. Langenberg, MD, Jeroen Bosch Ziekenhuis, Department of Anesthesiology, Postbus 90153, 5200 ME’s Hertogenbosch, The Netherlands; e-mail: clan{at}wish.net
Study objectives: To evaluate the placement and complications of a coronary sinus (CS) catheter in human subjects.
Design: Sixty-two CS catheters inserted in patients scheduled for coronary artery bypass graft surgery (CABG).
Setting: University hospital, anesthesia and cardiothoracic surgery departments.
Patients: Sixty-two patients without valvular or concomitant diseases undergoing CABG.
Interventions: CS fluoroscopy, measurements of CS flow, CS oxygen saturation, and CS distal tip pressure before incision, after incision, 20 min after aortic cross-clamp release (X-off), 50 min after X-off, 2 h after X-off, 4 h after X-off, and 6 h after X-off.
Results: In 57 patients (92%), we achieved successful CS catheter placement. In five patients (8%), CS catheter positioning was not possible. Of the 57 CS catheters placed, dislocation occurred during the operation in six patients (11%) and postoperatively in three patients (6%). Cardiac complications of CS catheter placement occurred in nine patients (15%). Four patients (6%) acquired hemopericardium. Three of these patients had a small hematoma in the right ventricle. In two other patients, contrast medium appeared in the right ventricular wall during catheterization. No hemodynamic signs of these complications were detected clinically. Irregular heart rhythm was observed in only three patients. CS blood oxygen saturation ranged from 40 to 60%. CS flow amounted to 3% of cardiac output. Variations in CS flow paralleled changes in cardiac output.
Conclusions: A CS catheter is a useful tool for clinical human cardiac research; however, the placement of a CS catheter can cause minor myocardial damage in > 10% of patients. Importantly, this damage may not be clinically evident, but only observed after thoracotomy. CS oxygen saturation, CS flow, distal tip pressure, and fluoroscopy are reliable tools to assess a safe and correct positioning of the CS catheter.
Key Words: coronary artery bypass graft surgery • coronary sinus catheterization • coronary sinus flow • myocardial damage
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