Coronary sinus perfusion for preservation of jeopardized myocardium

The use of the coronary sinus route to protect ischemic myocardium was proposed by PRATT as early as in 1898 [1]. Several investigators have since reported on beneficial effects of coronary sinus manipulations. During the first period of coronary sinus interventions, permanent coronary sinus ligation and arterialization were applied. Adverse effects such as engorgement of the venous system, hemorrhages and deterioration of cardiac performance contributed to a temporary demise of this method. Finally, with the enormous advancement of open heart surgery and especially coronary bypass grafting, coronary sinus manipulations completely lost their rationale. It is the result of advanced medical instrumentation and interventional cardiology that the coronary sinus route became once more an attractive access route to deprived myocardium. In the past, coronary sinus manipulation aimed at revascularization of ischemic zones by major surgery. Nowadays, percutaneous catheters are used to protect ischemic myocardium temporarily until ultimate revascularization is available.