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

[Donald Ross]

It doesn't actually jump up and say "Hi!" like Mr Hanky but it  
remains as a discrete easily identifiable entity, particularly within  
the pericardium.
Don
On 08/06/2007, at 12:39 PM, Mitch Lirtzman wrote:

> 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
>>>>>>
>>>>>>
>>>>>>
>>>>>> ************************************** See what's free at
>>>>>> http:// www.aol.com.
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