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

[Donald Ross]

evidence based medicine
On 07/06/2007, at 5:52 PM, Nasser F. Abou'Seada wrote:

> "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
>> >
>> >
>> >
>> > ************************************** See what's free at http://
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>
> -- 
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC
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