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

[Mitch Lirtzman]

Don,
It sits up even when dropped down into the mediastinum and the lung gloms 
over it? M.At 07:51 PM 6/7/2007, you wrote:
>Mitch,
>You must have done a re-do with a patent ima and found the artery to
>be imbedded in the scared remnants of the peri-arterial  tissue
>including the veins making  it difficult to locate and dissect ,
>particularly if you need to gain length to rotate the heart.
>If the ima has been skeletonised there is no such scaring and the ima
>sits up prettily like an undiseased SVG.
>Don
>
>On 08/06/2007, at 10:25 AM, Mitch Lirtzman wrote:
>
>>Frankly, I can't as I can honestly say I haven't had the occasion
>>to do so. However, the fortunately exceptionally few I've had to
>>take back shortly after surgery seem to have been quite viable. To
>>be honest, for those re-explorations I have done, I just look to
>>see there's no bleeding from the vessel and that's all that's
>>necessary. I doubt anyone in that situation would evacuate the
>>clot, identify any source(s) of bleeding, wash things out quickly
>>and then look closely enough to say "AHA, those little veins are
>>thrombosed!" before closing as expeditiously as possible. I don't
>>mean to sound flip about it. I've just never checked.
>>MitchAt 12:49 AM 6/7/2007, you wrote:
>>>Mitch,
>>>How do you explain the fact that the ima veins are always thrombosed
>>>if you, unfortunately,  have an opportunity  to inspect  them next
>>>day?
>>>Don
>>>
>>>On 07/06/2007, at 2:54 PM, Mitch Lirtzman 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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