Factors Predicting Coronary Sinus Rupture Following Cannula Insertion for Retrograde Cardioplegia

Background Coronary sinus rupture (CSR) is a rare preventable complication of cannula insertion for retrograde cardioplegia. In the hands of an inexperienced surgeon, this complication has the risk of potential mortality and morbidity, and its repair is technically challenging. Techniques for repairing CSR have been reported previously. In this study, we determined predictors of CSR following coronary artery bypass graft (CABG) surgery. Methods Over a four-year period, we retrospectively analyzed 1500 patients in whom a retrograde coronary sinus catheter was used to administer cardioplegic solution. CSR occurred in 15 patients. (12 women and 3 men). Variables such as age, weight, body mass index, gender, aortic clamp time, pump time, cardiomegaly, ejection fraction, and number of grafts were determined for each patient. Factors correlated with CSR were analyzed using multiple regression analysis, and odd ratios of significant variables were determined. Results In multiple regression analysis, factors such as female gender, age, weight, and body mass index showed a significant correlation with CSR, and their odd ratios were 4.2, 1.0, 0.96, and 2.2, respectively. Conclusion In all 15 cases, a retrograde cannula with a self-inflatable balloon was used and 12 patients were woman with low body mass index. Forceful insertion due to coronary sinus web, fragility of arteries in thin patients, or a small coronary sinus caused CSR in the hands of an inexperienced surgeon

Ramification Of The Portal Vein At The Porta Hepatis In Humans

The ramification of the portal vein at the porta hepatis was studied by anatomic dissection performed in 32 formalin fixed human livers. In all the specimens there were branches which ran towards the caudate lobe, arising from the portal vein and either from the left or the right portal branches. Tri- and quadrifurcation of the portal vein was observed. In 5 cases (16%) there were branches arising from left portal branch or portal vein and directed anteriorly to the quadrate lobe or to the region of the gall-bladder sulcus. These branches ranged from 1.0 to 6.0 mm in diameter. The portal caudate branches were divided into 3 groups. Group 1: Branches to the papillary process; 1 or 2 branches in 26 cases (82%), 3 or 5 branches in 3 cases (9%) and no branches in 3 cases (9%); Group 2: Branches to the vena cava region, including the left part of the caudate process; 1 or 2 branches in 30 cases (94%), 3 branches in 1 case (3%) and no branches in 1 case (3%); Group 3: Branches to the right part of the caudate process; 1 or 2 branches in 12 cases (37%), and no branches in 20 cases (63%).171353