Anesth Analg 2003;97:291-292
© 2003 International Anesthesia Research Society
LETTERS TO THE EDITOR
A New Technique for Pulmonary Arterial Catheter Insertion into Coronary Sinus Using Transesophageal Echocardiography
Yoshihiro Ishikawa, MD,
Tetsuya Miyashita, MD,
Yasuhiro Koide, MD,
Michihiro Sakai, MD,
Tomio Andoh, MD, and
Yoshitsugu Yamada, MD
Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan
To the Editor:
The coronary sinus (CS) catheterization guided by transesophageal echocardiograph (TEE) was reported previously (1,2). We examined a new, easier technique for insertion of a 7.5F pulmonary arterial catheter (PAC) with oxymetry (OpticathTM, Abbott Laboratories, Abbott Park, IL) into the CS guided by TEE in 11 subjects. After insertion of TEE probe, OPTICATH cath-eter tip was inserted into the right atrium via the right internal jugular vein and 1.5 mL of the saline was injected into the tip balloon (Fig. 1A). Twisting the catheter and advancing it forward, the tip balloon was guided to the orifice of the CS (Fig. 1B). The catheter was advanced into the CS, followed by balloon deflation and value of coronary sinus venous oxygen saturation (ScsO2) rapidly drops on the monitor (Fig. 2). After this technique, the catheters were successfully inserted in all cases and the catheter was inserted into the CS within 30 min (median = 16 min; range, 2–29 min).
View larger version (112K):
[in this window]
[in a new window]
|
Figure 1. (A) The catheter tip was inserted into the right atrium and 1.5 mL of the saline was injected into the tip balloon. (B) The tip balloon was advanced to the orifice of the CS. CS = coronary sinus, RA = right atrium, RV = right internal jugular vein, TV = tricuspid valve.
|
|
View larger version (94K):
[in this window]
[in a new window]
|
Figure 2. A rapid decrease of ScsO2 on the monitor shows insertion of the catheter into the coronary sinus.
|
|
Using this technique, common PAC can be used for continuous monitoring of ScsO2, which shows the balance of whole myocardial oxygen supply and demand (3,4). Furthermore, other information could be obtained through this catheter, such as lactate production that reflects myocardial metabolic state.
References
- Plotkin IM, Collard CD, Aranki SF, et al. Percutaneous coronary sinus cannulation guided by transesophageal echocardiography. Ann Thorac Surg 1998; 66: 2085–7.[Abstract/Free Full Text]
- Clements F, Wright SJ, de Bruijn N. Coronary sinus catheterization made easy for port-access minimally invasive cardiac surgery. J Cardiothorac Vasc Anesth. 1998; 12: 96–101.[Medline]
- Kumon K, Kuwabara M, Hirata T, et al. Continuous measurement of coronary sinus oxygen saturation after cardiac surgery. Crit Care Med 1987; 15: 595–7.[ISI][Medline]
- Crake T, Canepa-Anson R, Shapiro Le, Poole-Wilson PA. Continuous recording of coronary sinus oxygen saturation during atrial pacing in patients with coronary artery disease or with syndrome X. Br Heart J 1988; 59: 31–8.[Abstract/Free Full Text]
