By Siavosh Khonsari, Colleen Flint Sintek
Now in its Fourth version, this article is a realistic, seriously illustrated advisor to strategies in cardiac surgical procedure. Chapters disguise got and congenital ailments and comprise surgical anatomy, surgical exposures, and step by step procedural info. The authors point out pitfalls with a chance signal and flag issues of unique 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 center transplantation. additionally incorporated are updates in minimally invasive surgical procedure and vascular and endovascular surgical procedure.
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Additional info for Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, 4th Edition
The cannula must never be too large and should be introduced into the arterial lumen in an area that is relatively disease free. FIG 2-11. Traumatic aortic wall dissection during introduction of a cannula. Injury to the Femoral Artery A tourniquet or clamp used to tighten the umbilical tape around the proximal femoral artery and cannula may injure the wall of the artery. This can be avoided by placing a peanut sponge under the umbilical tape before tightening it. Femoral Artery Dissection The surgeon should always look for a column of pulsating blood in the femoral cannula; in the absence of obvious pulsation, it is very likely that the cannula tip is not in the lumen of the vessel.
The heart usually starts to beat soon after the aortic cross-clamp is removed. When warm blood is administered in a retrograde manner as the aortotomy is being closed in patients undergoing aortic valve replacement or as the atriotomy is being closed in patients undergoing mitral valve surgery, the heart may at times begin to beat spontaneously before the removal of the aortic cross-clamp. Every cardiac surgery team has its own preference for deairing the heart. We use the following technique. The venting system, if used, is clamped, and the heart is allowed to fill slowly by reducing the venous return.
2-2). Often it helps to mobilize the aorta to ensure its complete cross-clamping. In primary cardiac surgeries, the area between the pulmonary artery and aorta is dissected in a limited manner to allow a large curved or right-angled clamp to be passed behind the aorta. In redo surgeries, some sharp dissection behind the aorta must be carried out as well. When a clear passage is created, the clamp is used to pass an umbilical tape around the aorta. Traction on the tape allows the aorta to be lifted out of its bed (Fig.