Rv: [HSF] ima dilatation

Wed Aug 1 12:25:07 EDT 2007

I injet papaverine into the endothoracic fascia near the LIMA prior to dissection. I also injet papaverine into the fascia near mammary once dissection completed. I have regretted injecting the LIMA directly (damage)

Tomas

----- Original Message -----
From: openheart-l-bounces at lists.hsforum.com <openheart-l-bounces at lists.hsforum.com>
To: Forum Heart Surgery Forum <openheart-l at lists.hsforum.com>
Sent: Wed Aug 01 10:57:21 2007
Subject: Rv: [HSF] ima dilatation

----- Mensaje reenviado ----
De: Jorge Rodriguez Campos <jrodriguezcampos at yahoo.com>
Para: OpenHeart-L at lists.hsforum.com
Enviado: lunes, 30 de julio, 2007 12:01:21
Asunto: Re: [HSF] ima dilatation

Dear Mark, Don an other.
                                        Skeletonización IMA, after heparinized, to cut distal, to see the flow and clipped, an then can inmerse in papaverine diluted.-( see the image)
                                         20 minutes after the graft has better flow and diameter.-

                                                         Jorge Rodriguez Campos

----- Mensaje original ----
De: Donald Ross <donross at bigpond.com>
Para: OpenHeart-L at lists.hsforum.com
Enviado: lunes, 30 de julio, 2007 4:19:19
Asunto: Re: [HSF] ima dilatation

Mark,
I think my unfortunate dissections with retrograde ima injection may  
have been related to the fine olive tipped needle from DLP which I  
used . I think it was "too sharp" and hopefully the 22G angiocath  
will be safer.
It must have been at least 10 years since I abandoned intra-luminal  
injection, so really the advantages can't be all that great.
Cheers,
Don
On 29/07/2007, at 2:13 PM, Mark Levinson wrote:

>
> On Jul 22, 2007, at 1:05 AM, Donald Ross wrote:
>
>> Tohru,
>> I appreciate the details of how you sex up the internal mammary.
>> I hope, somewhat different from the technique you use for the  
>> external variety.
>>
>> I like your  technique for intra-luminal injection and will start  
>> doing it again to avoid the advential band  which  was  not  
>> detected because the ima  was not fully dilated.
>>
>> BTW I use verapamil undiluted
>>
>>>
>
> Don:
>
> Skeletonization and then intraluminal injection allows you to  
> identify these bands (if any are left after skeletonized harvest)  
> and they are snipped with
> the fine coronary scissors before grafting.     I use the same  
> intraluminal injection as Tohru Asai (only with VG + Regitine) and  
> this confirms that the
> graft has high flow, no dissections and no strictures before I  
> gamble the fate of the patient on it.
>
> I think distal injection can be done safely, and the response is  
> immediate so you can then plan the case knowing the graft is OK or  
> not.
>
> If the IMA dissects with retrograde injection, it is most likely  
> that a flap already exists and you just made it more obvious.     
> Better to know before
> grafting than to find out in the ICU.   I find that local  
> dissections can be hidden under the pedicle in non-skeletonized  
> conduits.
>
> However, I have watched video of your dissection technique, and I  
> know that you take the vein, and not much is left...
>
>
> Mark
>
> Mark M. Levinson, MD
> Founder, Editor-in-Chief,
> The Heart Surgery Forum
> WWW: <http://www.hsforum.com>
> Email: <mmLevinson at hsforum.com>
>
>
>
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