ABSTRACT
T he coronary venous connections to the capillary bed of the heart have been described for nearly 100 years,1 yet it was not until the 1940s that clinical application of this concept to treat heart disease was employed by Beck.2 Since that time surgeons have intermittently used retrograde perfusion of the coronary veins to provide myocardial protec tion during periods of aortic cross-clamping.3'6 However up until 1987, cannulation of the coronary sinus was a cumbersome process requiring bicavai cannulation, cavai snares, an atriotomy and insertion of a catheter into the coronary sinus under direct vision. This changed with the introduction of “blind” insertion of the coronary sinus catheter through a pursestring in the right atrium, using a flexible stylet to stiffen the catheter, guiding its entrance into the coronary sinus with a finger on the atrio-ventricular groove.7 Although immensely facilitating adult retrograde cardioplegie techniques, catheter size was clearly too big to allow retrograde techniques to be applied to the infant and pediatric age range. In recent years, this discrepancy has been corrected with the introduction of 6F and 10F cardioplegia cannulas with an integral flexible stylet (Gundry RSCP Cannula, DLP, Inc, Grand Rapids, Michigan).
