[HSF] Abnormal LIMA

[psimha]

Very unwise for your fellow to come to Bangalore - We have now probably 
the highest concentration of cardiac surgeons in one city in the world 
!!! (Crossing 50 at the last count !!)
Prasanna
Donald Ross wrote:
> Yes!!
> You know all , I have seen it recently and had to discard half the ima!
> I will have to read the "no traction" riot act to my fellows, one of 
> whom is hoping to practice in your city next year.
> Thanks,
> Don
>
>> That is a "traction dissection" due to a friable LIMA and traction  
>> during dissection. I have seen this a  few times  when I was 
>> initially dissecting the LIMA but after making a "No traction" policy 
>> " I stopped having it. Basically  I have seen many people tugging on 
>> the LIMA during dissection  to get a better view . This causes a tube 
>> in tube dissection (usually distal where the initial dissection is 
>> done). I recently saw  one by a colleague who was in the LIMA taking 
>> down learning curve .
>> Prasanna
>> john pj wrote:
>>> 2 days back we operated  a 54 yr old man for LT main stenosis with 
>>> lesions in LAD and OM.The LIMA[2.5 mm in size] was harvested with 
>>> out  any difficulty  and  had good pulsation and flow when divided. 
>>> When we divided the distal end we noted that the  thick intima was 
>>> telescoping beyond the remaining layers. When it was cut opened the 
>>> intima was more opaue  and lacked the lustre of normal intima. The 
>>> thickened  Intima was sliding against other layers as if they are 
>>> separated. It was not like dissection. We did not see any localised 
>>> atherosclerosis plaques .
>>>   .
>>>   We exised about 3 cm LIMA and there was no change in teh 
>>> appearence . We went ahead with LIMA to LAD grafting takinkincare to 
>>> incluse all the layers cautiously.We are watching the patient 
>>> closely. We have low threshold to go back to replace it with a vein 
>>> in case  of any problems in the LAD territory.
>>>    Any comments?
>>>        ---------------------------------
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