North Broad Street. Philadelphia, PA 19140. In order to facilitate exposure of the coronary arteries during open cardiac procedures without the use of a second ...
Brief Communication
The Cardiac Rag
Michael M. Badellino, MD Nicholas C. Cavarocchi, MD Jack Kolff, MD Jeffrey B. Alpern, DO James B. McClurken, MD
In order to facilitate exposure of the coronary arteries during open cardiac procedures without the use of a second assistant, an experienced first assistant, or cumbersome hand-holding of the heart, we use a technique for easy exposure by the operating surgeon. This technique involves the use of stretched-out and rolled-up 4" x 4" gauze sponges placed in two positions: 1) through the aortopulmonary window; and 2) under the inferior vena cava. These gauze tapes can be positioned to expose each coronary vessel. This technique allows the free use of both hands by the operating surgeon, providing excellent exposure and stability of the heart while the distal anastomoses are being performed. With the heart exposed, a curved Favolaro clamp is used to place a stretchedout and rolled-up 4" x 4" sponge under the inferior vena cava. Similarly, a Favolaro clamp is used to place a 4" x 4" sponge through the aortopulmonarv window. Care must be exercised to avoid the left atrial appendage upon pullback of the closed curved clamp. To expose the left anterior descending arterial system (Fig. 1), the 4" x 4" sponges are stretched, then fixed with Kelly clamps on either side of the operative field. To expose the circumflex and obtuse marginals (Fig. 2), the ends of the 4" x 4" sponges farthest from the operating surgeon are lifted upward and towards the operating surgeon, then secured to the wound towels with Kelly clamps. These can be crossed to achieve added exposure. (The wound towels are themselves taped to the skin, of course.) To expose the right coronarv arterv and its tributaries (Fig. 3), the two ends of the 4" x 4" sponge closest to the operating surgeon are secured with Kelly clamps to the wound towels, and the remaining two ends of the 4" x 4" sponges are lifted cephalad and likewise are fixed to the wound towels with Kelly clamps. This technique can also be used in reoperative procedures.
From: The Department of Cardiothoracic Surgery Temple University Phlladelphla, Pennsylvanla
Address for reprints: Nlcholas C. Cavarocchl MD, Dlrector Cardlo-Pulmonary Transplantation, Temple University Hospital. 3401 North Broad Street. Philadelphia, PA 19140
Simple Exposure of the Heart
Fig. 1 Exposure of the left anterior descending arterial system.
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Simple Exposure of the Heart
V'oliime 15, Number -. 1988
Fig. 2 Exposure of the circumflex and obtuse marginals.
Fig. 3 Exposure of the right coronary artery and Its tributaries. IVC = Inferior vena cava
