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

[Nasser F. Abou'Seada]

"I believe there is no EBM on the subject"
What is EBM ???

NFA

On 6/6/07, Donald Ross <donross at bigpond.com> wrote:
>
> 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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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC