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

[Mitch Lirtzman]

Bright Red Blood. Immediately prior to anastomosis, I let the LIMA bleed 
freely..."BRB across the table"At 02:54 AM 6/7/2007, you wrote:
>"BRB across the table"
>What is BRB ?
>
>NFA
>
>On 6/6/07, Mitch Lirtzman <drmitch at cox.net> wrote:
>>
>>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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>--
>Nasser  F.  Abou'Seada,
>MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
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