Chapter category: Heart
Basic Considerations and Techniques in Coronary Sinus
Coronary Sinus Intervention in Cardiac Surgery, Second Edition
Edited by: Werner MohlISBN: 1-58706-006-X
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Chapter authors:
Werner Mohl
Thank God for the ingenious device of coronary ventricular channels, which relieve the myocardium from the coronary blood and thus prevent accumulations of interstitial fluid' wrote Adam Christian Thebesius in 1703 in his thesis De circulo sanguine in corde.17 The drainage pathway so described was later named the Thebesian system which is one part of the lesser coronary venous system draining about 5–10% of coronary venous blood.
It was only in the late 1800s that the significance of this system was rediscovered by Langer8 stimulating further research in this area. In 1893 Pratt16 provided the basis for today's concept of coronary sinus interventions, since he observed that isolated feline hearts could be kept alive by retroperfusing arterial blood through the coronary sinus thus reversing coronary flow and he concluded: The nutrition of mammalian hearts is not totally dependent on coronary arteries. Some 40 years ago, and preceeding many of the enormous advances associated with modern cardiovascular medicine, Beck,2 Eckstein,5 and Gregg7 performed major experimental and clinical studies to relieve myocardial ischemia by permanent retroperfusion of the coronary sinus.
With today's understanding it was clear that this concept was the wrong goal and approach since it produced severe engorgement of the venous circulation. It is to the merit of a second generation (among them one of the contributors of the present book, S. Meerbaum10) to generate the modern concept of coronary sinus interventions for myocardial protection.
Today, coronary sinus interventions are generally understood to be methods of temporary protection of ischemic myocardium via the coronary sinus which include retroinfusion of cardioplegia during cardiac arrest in surgery, retroperfusion of arterial blood in settings of myocardial jeopardy (synchronized retroperfusion, SRP, and synchronized suction and retroinfusion, SSR), and manipulations of venous blood drainage by pressure-controlled intermittent coronary sinus occlusion, PICSO.12
Additional chapters from this book:
Coronary Venous Retroinfusion During Interventional Cardiology
Peter Boekstegers
During the past decade, several percutaneous support devices for coronary angioplasty have been developed with the aim of improving myocardial tolerance to ischemia, thereby increasing the ...
Coronary Sinus Interventions in Experimental Research: A Review
Harold L. Lazar and Richard J. Shemin
Despite optimal myocardial protection, ventricular dysfunction may still occur in the postoperative period following the revascularization of acutely ischemic myocardium. As more high risk pat...
Coronary Venous Interventions (Experimental Clinical Studies)
Samuel Meerbaum
The thrust of advances in interventional cardiology has been aimed at treatment of myocardial jeopardy associated with coronary insufficiency. With surgical coronary artery bypass firmly es...
Coronary Sinus Interventions During Surgical Treatment of Acute Myocardial
Friedhelm Beyersdorf
In many centers, coronary artery bypass grafting is currently considered during or soon after an acute myocardial infarction only after failed angioplasty. Emergency coronary artery bypass ...
Retrograde Cardioplegia in Infants and Children
Steven R. Gundry
The coronary venous connections to the capillary bed of the heart have been described for nearly 100 years,1 yet it was not until the 1940s that clinical application of this concept...
The Selection of Antegrade Versus Retrograde Cardioplegia Delivery
Flordeliza S. Villanueva, William D. Spotnitz, and Sanjiv Kaul
The optimal delivery of cardioplegia to induce and maintain cardiac arrest is fundamen-tal to myocardial preservation during cardiac surgery. Traditional approaches utilizing intracoronary ...
Distribution of Antegrade and Retrograde Cardioplegia-Experimental
Gabriel S. Aldea and Richard S. Shemin
Previously published clinical series do not reflect the evolution of myocardial protection, anesthetic, and surgical revascularization techniques. Despite the relentless progressive increase i...
The Hazards of Ischemia/Reperfusion Injury During Revascularization
Katharina Palisek, Günter Steurer, Hans-Henner Becker and Werner
Enormous advances in surgical, pharmacological, and interventional techniques result-ing in early restoration of infarct artery patency significantly improved outcome in patients with acute co...
Computer Simulation and Modeling of the Coronary Circulation
Friederike Neumann, Martin Neumann, Rudolf Karch, and Wolfgang Schreiner
In the large field of physiological processes such as, for instance, transportation and delivery of substances in the circulatory systems of the body, computer experiments and simulation st...
Regional Differences and Variability in Left Ventricular Wall Motion
Werner Heimisch
In our understanding of the mechanical performance of the heart as a pump we mostly rely on the famous studies of Otto Frank1 and Ernest Starling2 whose observations h...
Structure and Function of the Cardiac Lymphatic System
Hubert Schad
The physiology of the lymphatic system lives like Cinderella at the side of her attractive sisters the physiology of the heart and of the circulation. Lymphatic vessels, however, have been ...
The Anatomical Basis of Coronary Sinus Reperfusion
Michael von Lüdinghausen, Masahiro Miura
The venous drainage system of the myocardium is divided in two parts (Fig. 1):
A. The great (major) cardiac venous drainage system (GCVDS) extends over the surface of the ventricul...
The Venous Drainage of the Myocardium in the Human Heart
Michael von Lüdinghausen, Nobuko Ohmachi and Shoji Chiba
The coronary sinus (cs) is the anatomically appropriate location for the placement of a balloon catheter for retrograde perfusion or revascularization, in particular of the vessels of the l...
Development of Blood Cardioplegia and Retrograde Techniques, The Experimenter/Observer Complex
Gerald D. Buckberg
A surgical colleague, Dr. Mohl, asked me to describe the course of develop-ments in myocardial protection coming from our studies during the past 28 years, as all seems to flow logically. S...
Basic Considerations and Techniques in Coronary Sinus
Werner Mohl
Thank God for the ingenious device of coronary ventricular channels, which relieve the myocardium from the coronary blood and thus prevent accumulations of interstit...
