ABSTRACT
The concept of ‘retrograde’ venous myocardial delivery has evolved over time. William Harvey first described the closed circulatory system, and correctly noted the relationship between coronary arteries and veins,1 and in the early eighteenth century anatomists and physiologists expanded the understanding of this complex vascular system.2,3 However, it was not until 1897 that F.H. Pratt first proposed and investigated the potential ‘nutritive significance of regurgitation ... into the coronary veins'.4 The first human ‘arterialization of the coronary sinus’ was performed in 1947, although it was quickly abandoned due to excessive myocardial damage, and associated mortality.5 Unwilling to sacrifice this potential avenue to the heart, many investigators have expanded and improved coronary venous interventions for intermittent coronary sinus occlusion, retroperfusion of oxygenated blood and retroinfusion of myocardially active substances.6-9 The combined work in this field over the past five decades has produced coronary venous techniques that remain in surgical use today.10,11 The major applications in clude retroinfusion of cardioplegia in the arrested heart, which is now a well-established clinical technique, intermittent coronary sinus occlusion during antegrade cardioplegic delivery in the arrested heart, and in the early reperfusion period after surgical revascularization.
