Cardiac Surgery: Safeguards and Pitfalls in Operative by Siavosh Khonsari

By Siavosh Khonsari

He long-awaited moment version of this winning textual content maintains to supply the most up-tp-date, confirmed counsel for boosting operative method and keeping off capability problems. A gentle writing type included with step by step illustrations deals a brilliant presentation of the main crucial wisdom, together with administration of contaminated sternal wounds; fix of the mitral valve with sleek prosthetic earrings; correction of the pulmonary artery sling; functionality of coronary artery skip graft surgical procedure with minimum suggestions; administration of Epstein's anomaly within the neonate; and masses extra. either grownup and pediatric instances obtain plentiful insurance. Pitfalls and blunders are highlighted all through with a risk signal; and Nota Bene (NB) notations are used to stress issues of specific significance

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Sample text

The arterial return into the false lumen is responsible for excessive pressure in the arterial line while the actual perfusion of the patient is inadequate. This leads to a decrease in venous return. If this complication occurs, perfusion should be immediately stopped. The femoral artery or the external iliac artery on the opposite side should then be cannulated if not involved; otherwise, the ascending aorta, the subclavian or axillary artery must be cannulated. Traumatic Disruption and Dissection of the Ascending Aorta Intraoperative traumatic dissection or disruption of the ascending aorta is a rare but dramatic complication of open-heart surgery.

Submammary right thoracotomy skin incision. Note the location of the chest tube. to the chest wall, and the pectoralis major and pectoralis minor insertions onto the ribs are dissected free up to the fourth interspace. The intercostal muscle is divided just on the upper edge of the fifth rib, and the pleural space is entered. Two single-blade retractors are placed: one between the ribs and the other at a right angle to the first retractor to spread the subcutaneous tissue and muscle. A lung retractor is then used to hold the right lung laterally (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. 2-25). FIG 2-25. Use of a Hemashield tube graft for aortic disruption. 3 Myocardial Preservation Myocardial protection has clearly made open-heart surgery a safe and reproducible technique. There continue to be many modifications of the chemical composition of the cardioplegic solution, the optimal temperature (cold or warm), and the route of infusion (antegrade or retrograde).

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