The Annals of thoracic surgery
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Retrograde delivery of cardioplegic solutions has recently been the subject of renewed interest, but the reliability of this technique has not been assessed in large clinical series. From 1980 to 1989, we used retrograde coronary sinus perfusion as the exclusive means of cardioplegia delivery in 500 consecutive patients undergoing aortic valve replacement, either isolated (359 patients) or combined with another valve or coronary procedure (141 patients). The coronary sinus was always cannulated under direct vision after bicaval cannulation with snaring. ⋯ There were three nonfatal coronary venous injuries during our early experience. We conclude that coronary sinus perfusion is a safe and effective means of delivering cardioplegia in aortic valve operations. While providing a degree of myocardial protection similar to that reported with anterograde cardioplegia, the coronary sinus technique offers distinct advantages, in particular, the avoidance of perfusion-related coronary artery complications and the opportunity to repeat cardioplegia administration without interrupting the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pulmonary embolism remains a problem in the United States in terms of both morbidity and mortality. New diagnostic modalities to make rapid diagnosis are now available, and allow for bedside diagnosis of pulmonary embolism without the use of pulmonary angiography. ⋯ Use of echocardiography, a device readily available even in small institutions, allowed for early diagnosis and institution of therapy in this particular case and in others. Diagnostic features of pulmonary embolism are discussed and the literature is reviewed.