Re: [½ðɽ¶¾°Ôʶ±ð´ËÓʼþΪÀ¬»øÓʼþ][HSF] Simplified Top End

[陈鑫]

Dear Mark:

It is a great job but was the RIMA avaible for the inflow to the RCA, or is OPCAB more suotbal for this case?

Thanks 

steve 

----- Original Message ----- 
From: "Mark Levinson" <mmlevinson at hsforum.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Thursday, November 22, 2007 2:53 PM
Subject: [½ðɽ¶¾°Ôʶ±ð´ËÓʼþΪÀ¬»øÓʼþ][HSF] Simplified Top End


> Forum:
> 
> I did a challenging case today with nearly total aortic calcification  
> (everything from the blue mark distally).
> Needed 3 grafts.    There was only one soft spot near the RCA ostium  
> for a top end, so I built a single top end servicing two directions.
> Pumped from the femoral artery and did this single top end with 3 and  
> 1/2 minutes of circ arrest at 30 C....
> Distals done beating/on pump during rewarming...Neuro intact in the  
> ICU....
> 
> The limb going to the OM flows in the usual direction, but the limb  
> to the RCA flows against the valves, so I first passed
> a Leather valvulatome and confirmed no competent valves remaining by  
> injecting saline in both directions.
> 
> This was the simplest top end ever...no punch, just one linear aortic  
> incision and one running suture line.    The hood
> looks plentiful and wide open.
> 
> Has anyone done a top end like this before???
> 
> Mark
> 
> P.S.   Photo taken with my iPhone!....
> 
>


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