[HSF] circumflex in the groove

[jbflegejr at aol.com]

Grafting the circumflex in the a-v groove in a patient with no previous operations need not be difficult. Open the  pericardium on the right well back toward the phrenic nerve, open the right pleural cavity, cannulate for venous drainage as you might for a transplant (one cannula directly into the SVC and the other through the atrium close to the SVC) so that cannulas do not get in the way of rotating the heart into the right chest. Then rotate the heart to the right beneath the sternum into the right chest and that flattens out the lateral aspect of the LV and enables work on the circumflex without any more retraction and with very nice exposure. Use of the bipolar cautery for hemostasis in the fat is helpful. John Flege


-----Original Message-----
From: Roberto Battellini <robertobattellini at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Tue, 30 Sep 2008 12:36 pm
Subject: RE: [HSF] circumflex in the groove








and read before the article written by John Flege, all the necessary details are 
there.John is a cavalier and doesn´t mention his paper.I did this approach 4 
times on the beating heart with pleasure, but take care the aorta could be very 
calcified and in that case go to the axillary.
Roberto> From: Jbflegejr at aol.com> Date: Tue, 30 Sep 2008 11:34:28 -0400> 
Subject: Re: [HSF] circumflex in the groove> To: OpenHeart-L at lists.hsforum.com> 
CC: > > In a reoperation the circumflex in the AV groove is best approached by 
left > thoracotomy. Since the IMA is in use, a S
VG or radial artery would be Ok 
with > the proximal anastomosis to the descending aorta if it is not too 
diseased, the > subclavian artery if you can reach it which should be possible 
through the > 4th IS and awkward thfough the 5th IS, or the axillary artery 
exposed by > subclavicular incision. I certainly would graft it if it is the 
cause of her > symptoms. John Flege> > > > **************Looking for simple 
solutions to your real-life financial > challenges? Check out WalletPop for the 
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