[HSF] Intramyocardial LADs

[erdinç naseri]

Michael,
In our experience with intramural LADs we never had problem finding the vessel if it was a pure intramural one .The real problem is in a patient with intramural LAD and on top of that a good thickness of epicardial fat .This makes:1.Handling the perivascular tissue almost impossible.
2.Severe oozing which is an important problem in OPCAB.
remedies:1.Use traction sutures
2.make the fat incision by low voltage electrocautery.
If no visualization of the vessel then make a small arteriotomy in the distal LAD  and put a small piece of vein graft there without tying the toe of  the graft. Put a 2 mm probe through the toe and retract the sutures so that no bleeding will occur. Proceed proximaly and feel the probe and continue incising downward.
erdinc> Date: Wed, 4 Jul 2007 11:43:55 -0400> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] Intramyocardial LADs> > I seem to be seeing more and more of these, they dive down deep into the LV> and finding them without ripping apart the heart is a real pain. How do> others deal with these - particularly when the obstruction in distal to the> only part you can find? I few that I have seen recently would have been a> disaster had I been trying to do the case off pump.> > Very frustrating> > -michael> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------