By Siavosh Khonsari, Colleen Flint Sintek
Now in its Fourth variation, this article is a realistic, seriously illustrated consultant to tactics in cardiac surgical procedure. Chapters conceal obtained and congenital ailments and contain surgical anatomy, surgical exposures, and step by step procedural information. The authors point out pitfalls with a probability signal and flag issues of distinctive curiosity with "NB" (Nota Bene). This version has contributions from Abbas Ardehali, MD, FACS, the director of the UCLA center, heart-lung, and lung transplant software. Highlights comprise a brand new bankruptcy on middle transplantation. additionally incorporated are updates in minimally invasive surgical procedure and vascular and endovascular surgical procedure.
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Extra resources for Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, 4th Edition
The pericardial cavity is filled with warm saline and the aortic arch and ascending aorta are scanned. Porcelain, Lead Pipe, or Eggshell Aorta Porcelain, lead pipe, or eggshell aorta is the term used when the entire ascending aorta is calcified. Cannulation or clamping of this kind of aorta has catastrophic complications, namely, strokes and uncontrollable hemorrhage. In such cases, the femoral or axillary artery and right atrium are cannulated and the aorta is replaced or dealt with under deep hypothermic circulatory arrest (see Management of Porcelain Aorta in Chapter 5).
A flexible, hand-held, soft-tipped cannula with a collar around the tip can provide satisfactory infusion of cardioplegic solution directly into the coronary arteries (Fig. 3-1A). The collar presses against the aortic wall and the coronary ostium to prevent spillage of cardioplegic solution into the aorta. Myocardial Preservation by the Retrograde Perfusion Method Retrograde infusion of cardioplegic solution into the coronary sinus is very efficient, but its effectiveness in perfusing the right atrium, right ventricle, and inferior wall of the left ventricle may not always be adequate.
Repair of a tear in the left ventricular apex. Tearing or Bleeding When there is a tear or excessive bleeding from the left ventricular apex, the heart is decompressed. Long strips of Teflon felt with nonabsorbable sutures are used to repair the tear (Fig. 4-2). This is probably most safely accomplished with the heart arrested with cardioplegia. Air in the Ventricular Cavity If suction is too great or the apical opening is too large, air may be sucked into the left ventricular cavity around the vent site.