Fig 2 - available from: Journal of Cardiothoracic Surgery
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Illustration of cardioplegia infusion technique. a. Aorta-cross clamping (ACC) and antegrade cold cardioplegia infusion. Blood clots in the cardioplegia line and coronary artery; b. Cardioplegia line change and retrograde warm cardioplegia infusion; c. Coronary artery opening, and elimination of blood clots; d. Washing out of the coronary artery with simultaneous antegrade and retrograde crystalloid cardioplegia infusion, with the coronary artery open; e. Intermittent warm blood cardioplegia infusion in an antegrade and retrograde manner during the main procedure; f. Warm blood cardioplegia infusion directly into the saphenous venous graft; g. Flushing out the warm crystalloid cardioplegia simultaneously via antegrade and directly from saphenous venous graft to the aorta opening, h. Proximal saphenous venous graft to aorta anastomosis. AAo: ascending aorta, Cap: capillary, CoA: coronary artery, CoV: coronary vain, RA: right atrium. Red color: blood cardioplegia, Blue color: crystalloid cardioplegia, Purple color: blood clot, Red dot: microemboli
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Background:
Cold hemagglutinin disease (CHAD) is a rare autoimmune disease, in which patients manifest symptoms when the body temperature decreases. It causes critical problems with blood clotting and hemolysis during hypothermia in cardiac surgery. Although various methods are recommended, the CHAD discovered incidentally during cardiac surgery i...
Contexts in source publication
Context 1
... was caused by CHAD, we stopped the cold cardioplegia infusion and changed the thrombosed cardioplegia line immediately. We infused the warm Journal of Cardiothoracic Surgery (2020) 15:79(35 °C) blood cardioplegia with high potassium in a retrograde manner to induce cardiac arrest and raised the temperature of the body and the operating room ( Fig. 2- b). After the cardiac arrest, we opened the LAD, posterolateral branch (PL) and obtuse marginal artery (OM) and found a few blood clots, which were eliminated and the coronary artery was irrigated inside with warm saline ( Fig. 2-c). With the coronary artery open, we infused warm-crystalloid cardioplegia simultaneously in an antegrade ...
Context 2
... in a retrograde manner to induce cardiac arrest and raised the temperature of the body and the operating room ( Fig. 2- b). After the cardiac arrest, we opened the LAD, posterolateral branch (PL) and obtuse marginal artery (OM) and found a few blood clots, which were eliminated and the coronary artery was irrigated inside with warm saline ( Fig. 2-c). With the coronary artery open, we infused warm-crystalloid cardioplegia simultaneously in an antegrade and retrograde manner to wash the hidden blood clots out of the coronary artery, and to protect the myocardium and raise the myocardial temperature ( Fig. ...
Context 3
... were eliminated and the coronary artery was irrigated inside with warm saline ( Fig. 2-c). With the coronary artery open, we infused warm-crystalloid cardioplegia simultaneously in an antegrade and retrograde manner to wash the hidden blood clots out of the coronary artery, and to protect the myocardium and raise the myocardial temperature ( Fig. ...
Context 4
... we infused high-potassium warm blood cardioplegia every 15 min in an antegrade and retrograde manner, followed by warm saline surface irrigation to maintain normothermia (36 °C, Fig. 2-e). After anastomosis of distal SVG to OM and PL, additional warmblood cardioplegia was directly infused through the SVG, to effectively eliminate hidden microemboli and perfuse warm blood cardioplegia to the distal coronary artery (Fig. 2-f). Before the anastomosis of the proximal SVG to the ascending aorta, we evaluated for the presence ...
Context 5
... antegrade and retrograde manner, followed by warm saline surface irrigation to maintain normothermia (36 °C, Fig. 2-e). After anastomosis of distal SVG to OM and PL, additional warmblood cardioplegia was directly infused through the SVG, to effectively eliminate hidden microemboli and perfuse warm blood cardioplegia to the distal coronary artery (Fig. 2-f). Before the anastomosis of the proximal SVG to the ascending aorta, we evaluated for the presence of residual clots in the ascending aorta through the small opening for the proximal SVG graft. Finally, we flushed out the warm crystalloid cardioplegia simultaneously in an antegrade manner and directly through the SVG to the aorta ...
Context 6
... 2-f). Before the anastomosis of the proximal SVG to the ascending aorta, we evaluated for the presence of residual clots in the ascending aorta through the small opening for the proximal SVG graft. Finally, we flushed out the warm crystalloid cardioplegia simultaneously in an antegrade manner and directly through the SVG to the aorta opening ( Fig. 2-g). After proximal SVG anastomosis, the LITA to LAD was anastomosed on the beating heart to reduce the ACC ...
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