ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00309.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractIntermittent hypothermic cardioplegia has been adopted as the method of choice for myocardial protection by most surgeons. The most important aspect of this protection is believed to be adequate hypothermia. An alternative technique has been developed, based on the principles of electromechanical arrest and normothermic aerobic perfusion using continuous warm blood cardioplegia. With this method of myocardial protection the heart is maintained at 37°C throughout the operative procedure. The specific technical aspects used shall be described in detail

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00310.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThis study was designed to determine the feasibility of anastomosing the internal mammary artery (IMA) and coronary artery with a carbon dioxide laser in a canine model. Twenty‐two mongrel dogs were randomly assigned to two groups: group I (n = 11) underwent laser‐assisted vascular anastomosis (LAVA) of the left IMA to the left anterior descending (LAD) coronary artery, whereas in group II (n = 11) the anastomosis was done with the conventional technique (handsewn). Laser methodology was used to micro‐weld vessels utilizing a power of 200 mW with a spot size of 500 μ, producing an effective power density of 102 W/cm2and energy fluence of 9, 172 joules/cm2in a continuous mode at a distance of 2 cm. The short‐term patency rate, measured at 2 hours after completion of the anastomosis, was 100% in both groups. The time required to perform the LAVA in group I was significantly shorter than group II (6.27 ± 0.47 vs 11.6 ± 0.67 min, p<0.05). The mean anastomotic bursting pressure in group I was significantly lower compared to group II (348 ± 8 vs 402 ± 9 mmHg, p<0.05). Histologic evaluation of all vessels showed moderate thermal injury of the adventitia and media in the laser group. Scanning electron microscopy exhibited a smooth anastomotic area in group I, whereas endothelial and perianastomotic changes with multiple needle craters occurred in group II (conventional anastomosis). Based on the results of this study, we conclude that a low powered CO2laser can be used to safely perform an IMA to LAD artery anastomosis, thus providing an alternative to conventional techniques because of its rapidity and minimization of anastom

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00311.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractAn alternative method to create an intraatrial, cavocaval channel without using any prosthetic material in total cavopulmonary connection is described. This new technique avoids possible thrombotic complication, limitation of heart growth by intraatrial prosthetic material, and reduction in secretion of antinaturetic peptide.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00312.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractIntimal tear resection and primary anastomosis of the aorta were used for the treatment of eight patients with DeBakey I and II type acute aortic dissection. Five patients were of DeBakey I type, and three patients were of the II type. Moderate or severe aortic regurgitation (AR) was observed in six of eight patients. The site of the intimal tear was diagnosed by intraoperative echocardiography, and the adventitia corresponding to the intimal tear was transversely opened under total cardiopulmonary bypass. While resuspension of the aortic valve was performed on only one of six patients, AR disappeared in four, postoperatively. Two of eight patients died early postoperatively. The cause of death was postoperative cardiac tamponade in one patient and cerebral herniation in the remaining one. The other six patients have been observed for a mean period of 27 months. There is no late death, and they show no dilatation of the aortic root and deterioration of AR. We believe that this operative method is a simple and safe emergency procedure for DeBakey I and II type acute aortic dissection.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00313.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThe demonstrated superior long‐term patency of the internal mammary artery (IMA) over the saphenous vein (SV) has prompted the use of other arterial grafts, particularly for younger patients and patients without a suitable SV. We have used the single or bilateral inferior epigastric arteries (IEA) as a detached arterial conduit in 27 patients undergoing coronary artery bypass operations (CABG). In this report we describe the surgical anatomy of the IEA, preoperative noninvasive evaluation by duplex scan, our harvesting technique, and early surgical experienc

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00314.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractA new modified surgical approach for the division of posterior septal accessory pathways is described. This method incorporates some of the desirable components of previously reported techniques, while eliminating difficult and unreliable aspects of those same techniques. Interestingly this procedure was initially illustrated by Sealy and Mikat1in 1983, although it has not been used clinically until now. The recognized intent of this dissection is to totally separate atrial and ventricular structures within the posterior septal space so that all accessory pathways encountered are permanently interrupted.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00315.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractHarvest of arterial grafts causes varying degrees of vascular spasm. Preparation of the internal mammary graft by intraluminal injection of diluted papaverine solution (60 mg of papaverine in 40 mL of normal saline) allows graft dilatation to occur while pericardiotomy, cannulation, etc., is performed. Advantages are an increased mammary graft size with less chance of technical error, elimination of spasm with improved flow rates, and the identification of unclipped or uncauterized branches that may require reexploration. Newer vasodilating agents may prove even more effective in the future.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00316.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThe described internal mammary artery (IMA) preparation reduces several shortcomings of the IMA graft procedure. The technique increases vessel diameter through single plane pedicle fascial incision assisted by gentle balloon dilatation. Trauma to the intima from instrumentation is minimized due to the atraumatic nature of a soft air‐filled balloon catheter and avoidance of shear forces exceeding 40 g. The increase in vessel diameter effected by balloon dilatation creates a larger hood area to facilitate the distal anastomosis. The technique also maximizes the length of the IMA for sequential graftin

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00317.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractPreparation of the internal mammary artery (IMA) for coronary bypass grafting is depicted. It is felt that this technique offers a simple, safe method for providing an IMA of maximum caliber and flow that allows not only end‐to‐side but sequential IMA grafting to a coronary artery. Use of this technique prepares the mammary artery to be used for both in situ and free grafting procedures to allow maximum utilization of the IMA as a superior conduit. The technique described has been used in several thousand operati

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1991.tb00318.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY