By Siavosh Khonsari
Now in its Fourth variation, this article is a pragmatic, seriously illustrated advisor to strategies in cardiac surgical procedure. Chapters conceal got and congenital ailments and comprise surgical anatomy, surgical exposures, and step by step procedural info. The authors point out pitfalls with a probability signal and flag issues of targeted curiosity with "NB" (Nota Bene).
This version has contributions from Abbas Ardehali, MD, FACS, the director of the UCLA middle, heart-lung, and lung transplant application. Highlights contain a brand new bankruptcy on middle transplantation. additionally incorporated are updates in minimally invasive surgical procedure and vascular and endovascular surgery.
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Additional info for Cardiac Surgery: Safeguards and Pitfalls in Operative Technique
Injury to the Sinoatrial Node The sinoatrial node is located at the superior end of the sulcus terminalis near the cavoatrial junction (Fig. 2-17). Injury to the sinoatrial node (Fig. 2-18) may cause temporary conduction disturbances, which can generally be managed with a temporary atrial pacemaker wire and the infusion of isoproterenol or dopamine in the immediate postoperative period. Rarely, it may be necessary to pace the atrium permanently. Injury to the Right Coronary Artery The right coronary artery follows a course in the right atrioventricular groove.
Two strips of Teflon felt are then sewn below the clamp (Fig. 2-24A). The suture line is then reinforced with an over-and-over continuous suture after removing the clamp (Fig. 2-24B). Alternatively, the torn segments can be excised and replaced with a patch of pericardium or Hemashield graft (Meadox Medicals, Oakland, NJ) (Fig. 2-24C). On the rare occasions when the edges of a tear in the aortic wall are too friable to hold any kind of sutures, the ascending aorta may have to be replaced with a Hemashield tube graft (Fig.
A tie around the tip of the right atrial appendage retracted inferiorly aids in cannulation of the superior vena cava and ascending aorta. Inability to Cannulate the Left Superior Vena Cava A left superior vena cava is not accessible from this approach. Difficult Ascending Aortic Cannulation The ascending aorta in older children and adults may be difficult to cannulate through this incision. The use of an arterial cannula with a tapered introducer may allow for safe and controlled aortic cannulation when aortic exposure is suboptimal.
Cardiac Surgery: Safeguards and Pitfalls in Operative Technique by Siavosh Khonsari