Live 3-dimensional echocardiography guidance for the insertion of a retrograde cardioplegic catheter through the coronary sinus

Objective. We evaluated the feasibility and accuracy of live 3-dimensional (3D) epicardial echocardiography (echo) to guide the insertion of a retrograde cardioplegic catheter into the coronary sinus. Methods. A real-time 3D echo system with a x4 matrix transducer was used. Live 3D echo-guided catheter insertion was compared with blind insertion. Completion times and success rates were recorded. During all experiments, the operator was blinded to the target and, in the echo-guided group, the procedure was performed with only ultrasonic guidance. Results. Live 3D echo provided sufficient spatial resolution and a satisfactory frame rate to provide a "virtual surgeon's view" of the relevant anatomy. Although there was no significant difference in completion time, live 3D echo guidance significantly improved the success rate of catheter insertion as compared to the blind group (90% versus 35%; P < .001). Conclusions. Live 3D echo-guided coronary sinus catheter insertion is feasible and safe.