[HSF] Another on vs off pump question, dilatation of IMA......

[Donald Ross]

John,
In the early days of routine ima use we did a trial comparing intra- 
luminal verapamil with high pressure topical papaverine.
After a set time which I forget the flow was measured by slicing off  
the ima just proximal to the distal branches and measuring the  blood  
volume. The improved flow thus measured was most impressive for the  
intra-lumunal group.

I think it probably matters little what you do with the ima providing  
there is no obstruction between the grafted artery and the aorta

The original question, however, was:  How to ensure the ima will have  
adequate flow to do the job.
The best way is to have an enlightened cardiologist as described by  
David who will not only image the subclavian but also  stent a stenosis.
An ima dissection or stenosis from and old injury can still pose a  
problem and that is why I like to feel a strong pulse prior to using  
the ima.
( Sorry it is only a subjective observation Tea but I believe there  
is no EBM on the subject. If there was, Prasanna would have found it. )
We convinced our cards to at least squirt some dye around the  
subclavian origin but they gave someone a stroke and gave up!
Don
On 07/06/2007, at 11:45 AM, Jbflegejr at aol.com wrote:

> Don, you and others have said that you clamp and divide the IMA and  
> lay it
> aside until time for the anastomosis, some with it wrapped in a  
> sponge soaked
> with papaverine and/or verapamil, some after injecting the same  
> drugs into the
>  lumen, and later found the IMA to be plump and pulsating. Perhaps  
> there is
> another explanation. When you open the IMA after it has been  
> clamped for some
> time, the blood in the lumen is dark, desaturated, meaning that the  
> oxygen
> has  been extracted, which must mean that the vessel wall has been  
> ischemic.
> Could it  be that when the smooth muscle cells become ischemic,  
> they lose there
> capacity  to contract and the vessel wall relaxes and dilates and  
> the drugs
> have nothing  to do with it? John Flege
>
>
>
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