Anatomy of the coronary sinus and its clinical significance for retrograde cardioplegia.

Liu Dao-ming, Zhang Fa-hui, Chen Long, Zheng He-ping, Zhong Shi-zhen

Department of Anatomy, First Military Medical University, Guangzhou 510515, China.

Di Yi Jun Yi Da Xue Xue Bao. 2003 Apr;23(4):358-60, 363.

OBJECTIVE

To provide an anatomical basis for selecting optimal retrograde cardioplegia technique therefore to improve the effect of the operation.

METHODS

Fifty formalin-fixed adult human cadaveric hearts were collected in this study, and special attention was given to the observation of the coronary sinus tributary drainage and the anatomical relationship between the orifice of the coronary sinus and the atrioventricular nodal artery.

RESULTS

Although the majority of the tributaries drained into the coronary sinus, it was identified in 15 cases that the posterior vein of the left ventricle and in another 2 cases the small cardiac vein (SCV) made their way into the middle cardiac vein (MCV) respectively. In 6 cases MCV solely joined the right atrium, which was joined by SCV only in 1 case. Draining into the coronary sinus as seen in 44 cases, MCV had an opening 3.4+/-1.5 mm away from the orifice of the coronary sinus. In the direction perpendicular to the long axis of the coronary sinus orifice, the anterior and posterior extreme points were 4.9+/-2.5 mm and 9.9+/-4.2 mm respectively, away from the atrioventricular nodal artery, which crossed the long axis of the coronary sinus orifice at an angle of 21.2+/-15.6 degrees. The right atrial wall on both sides of the coronary sinus orifice was of a uniform thickness of 1.1+/-0.2 mm.

CONCLUSIONS

Direct-vision non-balloon-tipped cannulation conforms better to the anatomical features described above. In purse-string suture, however, sufficient care should be taken of the dangerously thin inferior atrial wall and the close relationship between the coronary sinus orifice and the atrioventricular nodal artery. For better cardioprotective effect of retrograde cardioplegia, non-balloon-tipped cannula under direct vision should be adopted with the assistance of antegrade perfusion and, when necessary, additional transfusion via the exotic MCV opening may be used when the opening appears relatively wide.