By Siavosh Khonsari, Colleen Flint Sintek
Now in its Fourth version, this article is a realistic, seriously illustrated advisor to tactics in cardiac surgical procedure. Chapters disguise bought and congenital illnesses and contain surgical anatomy, surgical exposures, and step by step procedural information. The authors point out pitfalls with a threat signal and flag issues of specified curiosity with "NB" (Nota Bene). This variation has contributions from Abbas Ardehali, MD, FACS, the director of the UCLA middle, heart-lung, and lung transplant software. Highlights comprise a brand new bankruptcy on center transplantation. additionally integrated are updates in minimally invasive surgical procedure and vascular and endovascular surgical procedure.
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Additional resources for Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, 4th Edition
A diseased artery, faulty cannulation technique, and trauma produced by a high-velocity perfusion jet are major factors that may cause a tear of the intima with medial separation. It is therefore essential to introduce an adequately sized, beveled, smooth cannula into a relatively normal vessel in an atraumatic manner. The perfusion should be started gradually, with the surgeon being cognizant at all times of the possible occurrence of aortic dissection. The most significant diagnostic feature is low flow with high arterial line pressure in the circuit.
FIG 3-2. A: Perforation of the coronary sinus by a retrograde cannula. B: Coronary sinus tear. C: Suture closure of the coronary sinus tear using epicardial tissue. Perforation of the Coronary Sinus The stylet and cannula must be guided into the coronary sinus very gently and not be advanced if any resistance is encountered. The coronary sinus wall is very thin and can be perforated by the stylet or the cannula tip. A tear in the coronary sinus must be dealt with by closing the epicardium carefully over the tear with a fine Prolene suture (Fig.
If air still remains, the patient is placed in the Trendelenburg position, a large-bore needle is introduced into the apex of the left ventricle, and blood and air are aspirated. The right superior pulmonary vein, left atrial appendage, and roof of the left atrium between the superior vena cava and the aorta may also be subjected to needle aspiration. Needle Injury to the Left Ventricle When the left ventricle appears to be dilated and thin, and the patient's tissues are delicate, needle aspiration of the left ventricular apex may be hazardous and cause bleeding.
Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, 4th Edition by Siavosh Khonsari, Colleen Flint Sintek