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

[jbflegejr at aol.com]

Mitch, that is a very interesting observation. In the pedicled IMA 
preparation there must be some circulation from the IMA to the 
surrounding tissue avoiding stagnation in the lumen usually skeletonize 
the IMA. John


-----Original Message-----
From: Mitch Lirtzman <drmitch at cox.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 7 Jun 2007 12:54 am
Subject: Re: [HSF] Another on vs off pump question, dilatation of 
IMA......






John, I would respectfully disagree with part of the last posting. As 
one
of the "wrappers and extraluminal injectors", in well over two decades,
dark blood has never come out of the LIMA at the time of unclamping for
grafting. I'm one of the leave-it-on-the-pedicle guys with accompanying
veins. As stated, I don't skeletonize and have never had problems with
graft length. My guess is that the vasa vasorum remain intact...or 
whatever
circulation others have postulated, and the vessel remains a living 
organ.
BRB across the table. 

Mitch LirtzmanAt 08:45 PM 6/6/2007, you 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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