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LETTERS TO THE EDITOR

Utilization of a Retrograde Cardioplegia Catheter for Rapid Central Venous Infusion

Department of Anesthesiology Duke University Medical Center Durham, NC 27710 Department of Anesthesiology Durham Veterans Affairs Medical Center Durham, NC 27710

To the Editor:

Vascular injury during median sternotomy represents a rare, but potentially catastrophic, complication of thoracic surgery. Injury to the great vessels may necessitate emergent replacement of IV access. We describe a case involving innominate vein injury and subsequent interim use of a retrograde cardioplegia catheter to emergently transfuse directly into the right atrium.

A 72-year-old woman with a history of lung carcinoma (s/p right upper lobectomy and chest radiotherapy) was admitted 10 years ago with constrictive pericarditis and was scheduled to undergo median sternotomy for pericardectomy. Standard vascular access acquired preoperatively included a 16-gauge right antecubital venous catheter, a 20-gauge radial arterial catheter, and an 8.5F internal jugular venous sheath. During median sternotomy, profuse intrathoracic bleeding was encountered. Despite blood salvaging and emergent transfusions, a 2-L blood deficit ensued, resulting in hemodynamic instability. A 2-cm tear of the right innominate vein was identified, and the decision was made to cross-clamp the innominate vein to facilitate repair. Cross-clamping of the right innominate vein necessitated removal of the central venous catheter despite the immediate need for venous access. To provide for fluid resuscitation, a 15F Medtronic^TM (Minneapolis, MN) retrograde cardioplegia cannula (1–2) was inserted directly into the right atrium and connected to a 48-inch Arrow^TM (Reading, PA) IV extension set (Figure 1). The right innominate vein was repaired, and the patient was successfully resuscitated.

View larger version (89K): [in this window] [in a new window]   Photograph depicting retrograde cardioplegia cannula (A) and attached IV set (B).

References

1. Buckberg GD. Antegrade/retrograde blood cardioplegia to ensure cardioplegic distribution: operative techniques and objectives. J Cardiac Surg 1989; 4: 216–38.[Medline]
2. Menasche P, Piwnica A. Retrograde cardioplegia through the coronary sinus. Ann Thorac Surg 1987; 44: 214–6.[Abstract]

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