Back to 2014 Annual Meeting Posters
A Simplified Method to Confirm Retrograde Cardioplegic Catheter Position in Coronary Sinus in Minimally Invasive Valce Surgery
Kenneth K. Liao, Ioanna Apostolidou, Richard Madlon-Kay, K.P. Madhu, Kevin Liao, Emil Missov.
University of Minnesota, Minneapolis, MN, USA.
OBJECTIVE: Inserting retrograde cardioplegic catheter (RCC) into coronary sinus (CS) and confirming its position under transesophageal echocardiography (TEE) can be difficult in patients undergoing minimally invasive valve (MiniValve) surgery due to lack of contrast of RCC to the surrounding structure when its stylet is removed. We used agitated blood as contrast to enhance the visualization of RCC and CS under TEE to confirm the RCC position inside CS by injecting agitated blood via RCC. We studied the sensitivity and specificity of this method.
METHODS: The TEE probe was positioned to visualize CS. During MiniValve surgery a RCC with stylet was inserted through a stab wound in the lateral wall of right atrium (RA) and advanced into the CS under TEE. The stylet was removed and a syringe of 10 cc agitated blood was injected into the CS via RCC. RCC position in CS was considered positive only when agitated blood filled CS first and leaked back into RA after 2 cardiac cycles. RCC position in CS was considered negative when agitated blood was not first visualized in CS or agitated blood immediately filled RA within 2 cardiac cycles.
RESULTS: From April 2011 to May 2012, a total of 37 consecutive MiniValve surgery patients (26 aortic and 11 mitral valve) by a single surgeon underwent such study. There were 15 males. The average age was 69 +/- 13 years. CS was visualized by TEE in 33 patients. In the 33 patients with visualization of CS, 31 patients had RCC inserted into CS and had positive agitated blood test, with a sensitivity of 94% (31 out of 33). In 4 patients whose CS was not visualized and 2 patients whose CS was unable to be cannulated by RCC, the agitated blood test was negative in all of them, with a specificity of 100% (6 out of 6).
CONCLUSIONS: Injecting agitated blood as contrast via RCC is a simple, safe and cost-effective way to guide and confirm positioning of RCC in CS under TEE. Its high sensitivity and specificity make it a reliable method to confirm RCC position in CS in MiniValve surgery.
Back to 2014 Annual Meeting Posters