Comparison of Flow Differences amoiig Venous Cannulas
|
|
- Bennett Boyd
- 5 years ago
- Views:
Transcription
1 Comparison of Flow Differences amoiig Venous Cannulas Edward V. Bennett, Jr., MD., John G. Fewel, M.S., Jose Ybarra, B.S., Frederick L. Grover, M.D., and J. Kent Trinkle, M.D. ABSTRACT The efficiency of four methods of venous drainage during cardiopulmonary bypass was evaluated. Superior vena caval (SVC), inferior vena caval (IVC), right atrial (RA), and right ventricular (RV) pressures as well as RV blood flow were measured for tion with a single USCI 40F atrial, a single Sarns 51F cavoatrial, and double USCI 32F caval s with and without caval tourniquets. Measurements for all s were recorded in conditioned dogs during normothermic cardiopulmonary bypass with the heart beating, with the heart fibrillated, and with the apex of the heart elevated in the circumflex position. Venous drainage using double caval s with caval snares provided maximum decompression of the venous system (SVC pressure, - 3 f 1.52 mm Hg [standard deviation]; IVC pressure, t 2.67 mm Hg to mm Hg). However, decompression of the right side of the heart with this method was the poorest (RA pressure, mm Hg to 9.60 k 2.78 mm Hg; RV pressure, 5.67 t 0.82 mm Hg to mm Hg; RV vent flow, 96 t 4 ml/min to 370 t 50 ml/min). The caval s without tapes provided similar venous decompression but with better right-heart decompression (RA pressure, mm Hg to 0.60 t 2.51 mm Hg; RV pressure, 2.13 t 2.23 mm Hg to 11.6 t 0.89 mm Hg; RV vent flow, 29 k 5 ml/min to 75 t 4.5 ml/ min). The USCI 40F atrial provided less efficient decompression of the inferior vena cava (IVC pressure, 4.33 t 1.96 mm Hg to 7.17 t 3.46 mm Hg). The Sarns 51F cavoatrial had the most efficient right-heart decompression (RA pressure, t 2.19 mm Hg to -4.1 t 1.7 mm Hg; From the Division of Cardiothoracic Surgery of the University of Texas Health Science Center at San Antonio and the Audie Murphy Veterans Administration Hospital, San Antonio, TX. Accepted for publication Jan 5, Address reprint requests to Dr. Bennett, Division of Cardiothoracic Surgery, UTHSCSA, 7703 Floyd Curl Dr, San Antonio, TX RV pressure, -2.5 t 1.57 mm Hg to 4.6 t 1.2 mm Hg; RV vent flow, 0 rfr 7 ml/min to 26 rfr 9 ml/min). Placing the heart in the circumflex position adversely affected right heart decompression in all techniques except single tion with the 51F cavoatrial. Likewise, venous decompression was affected adversely in all techniques except double tion with caval snares. With the single 40F atrial, SVC and IVC pressures were both elevated. Only the SVC pressure was affected when the cavoatrial was used. A recent survey of 677 cardiovascular surgeons performing coronary artery bypass graft (CABG) procedures showed that 50.5% used one, 35.4% used two s, and 24.1% used two s with tapes [l]. Is one method really better than another, and do manipulations of the heart during CABG operation affect each method differently? A previous study from this laboratory showed that a large single venous catheter could drain the venous system effectively and decompress the right side of the heart when beating undisturbed in the pericardial cavity [2]. However, clinical experience with the cavoatrial has led us to believe that the catheter was positioned improperly during that study, invalidating the results. As described in that report, the cavoatrial was inserted to the 3 cm mark, and intermittent partial obstruction of the atrial opening was encountered [2]. The error was in positioning this according to the guide marker used in placing such s in dogs, which have a smaller right atrium; this positioned the atrial drainage ports too close to the inferior vena cava. The should be placed with the atrial drainage ports in the upper midatrial area for proper drainage. We undertook reevaluation of venous drainage using the USCI 40F, Sarns 51F cavoatrial, and double USCI 32F s with and without caval snares because we 59
2 60 The Annals of Thoracic Surgery Vol 36 No 1 July 1983 believed that the cavoatrial was positioned improperly in the first study, and because we wished to study the way that elevating the apex of the heart affected the efficiency of each method. The present study compared the efficiency of these venous drainage systems with the heart fibrillated to eliminate uncontrollable contractility variations in the right side of the heart at the time of measurement. This maintained coronary sinus flow and produced a situation of possible right ventricular (RV) distention. The portion of this investigation done with the heart beating served as a control against the previous study, except for the correct placement of the cavoatrial. Materials and Methods Three types of s were used to test the four techniques of venous drainage used most frequently in the clinical practice of coronary artery surgery [l]. These techniques and s were as follows: atrial tion through the atrial appendage into the midatrium using a USCI 40F venous ; cavoatrial tion through the atrial appendage using a Sarns 51F two-stage cavoatrial catheter positioned with the end in the inferior vena cava and the atrial ports in the upper midatrium, as determined by transatrial palpation; and caval tion using two USCI 32F catheters inserted through the atrial appendage and inferior atrial wall into the inferior and superior venae cavae, respectively, with and without caval tourniquets. Five conditioned adult mongrel dogs weighing from 22.7 to 30 kg each were anesthetized with chloralose, 100 mg per kilogram of body weight. Positive-pressure ventilation was maintained prior to cardiopulmonary bypass by a cuffed endotracheal tube using a Harvard pump respirator. A cutdown was made in the right side of the neck of each dog for placement of superior vena caval (SVC) and systemic arterial blood pressure catheters (Statham PE 150) through the internal jugular vein and carotid artery, respectively. The SVC catheter was positioned just below the confluence of the internal jugular and brachiocephalic veins in the superior vena cava. A cutdown was made in the right groin for placement of the inferior vena caval (IVC) pressure catheter (Statham PE 150), which was positioned in the midabdominal inferior vena cava by measurement and palpation from above the diaphragm. A median sternotomy was used to expose the heart. Following intravenous administration of sodium heparin, 3 mg per kilogram of body weight, an 18F arterial war; inserted into the right femoral artery and connected to an extracorporeal circuit consisting of a Bentley S-110 oxygenator and Sarns roller pump. Pressure catheters (14-gauge Jelco intracath) were inserted into the right atrium and right ventricle to measure right atrial (RA) and IW intracavitary pressures. Right ventricular and left ventricular (LV) vent catheters (Bardex 181F) were placed. The right vent was connected to a graduated cylinder positioned at the level of the right ventricle, approximately 40 inches above the oxygenator. The right side of the heart was isolated by snaring the main pulmonary artery with a tourniquet. Venous flow lo the right ventricle was measured in this manner. The LV vent was used for decompression of the ventricle only when the heart was fibrillated. The extracorporeal circuit was primed with Plasma-lyte solution, 20 ml/kg, and fresh heparinized whole blood was obtained from a donor animal just prior to each study. The ph was adjusted to 7.4 with sodium bicarbonate. The oxygenator was perfused with a mixture of 96% oxygen and 4% carbon dioxide at a rate of 4 liters per minute. The flow rate was kept between 70 and 80 ml/kg/min, with the mean arterial blood pressure at 60 mm Hg or higher. Normothermic cardiopulmonary bypass (37.5 C) was used in each procedure. A Beckman 411 recorder was used io monitor and record all pressures. All sets of catheters were used in each dog. The pressures and RV vent flow were recorded with the heart beating and with the heart electrically fibrillated, and measurements were repeated after the apex of the beating or fibrillated heart had been elevated out of the mediastinum toward the right hemithorax in the circumflex position. A 10-minute stabilization period was allowed following each manipulation and prior to obtaining measurements. The SVC, IVC, RA, and RV pressures and mean RV flow were compared for each -
3 61 Bennett et al: Flow Differences among Venous Cannulas tion technique. The data were analyzed using Student s independent t test. Results Right Ventricular Vent Flow With the beating heart of each study animal in the down position, double caval tion with caval snares provided the highest RV flow rate ( ml/min; Fig 1, Table). The 51F cavoatrial setup had the lowest RV vent flow at 0 t 7 ml/min (see Table). This value was significantly lower than those for the other techniques (p < 0.001). Results for the 40F atrial catheter and the double caval s without snares were not significantly different, but both techniques showed markedly better flows than the double caval s. With the heart of each dog electrically fibrillated in the down position, RV vent flow trends paralleled those found with the heart beating (see Table). Double caval tion provided the highest RV flow rate (370 t 50 ml/min), followed by single tion with the 40F atrial (75? 20 ml/ min), double caval tion (29 & 5 ml/min), and single tion using the 51F cavoatrial ( ml/min). The differences between RV vent flows in the 40F atrial and double caval s were significantly higher than in the 51F cavoatrial (p < 0.01) and the double s (p < 0.01). With the heart of each animal electrically fibrillated and elevated in the circumflex position, double caval tion with tapes showed the highest flow at 96? 4 ml/min (see Table). The double caval s without tapes had the next highest flow ( ml/min), followed by the 40F atrial (45? 8 ml/ min) and the 51F cavoatrial (26? 9 mi/ min). Results for both single- techniques were significantly lower than for double caval tion ( p < 0.01) and double caval tion (p < 0.01), but were not significantly different from each other ( p < 0.07). Superior Vena Caval Pressure The lowest SVC pressure with the empty, beating heart of each animal in the down position 200 I50._ c E \ -$ LL 50 0 ** P mno40fr USCI 0 51 Fr Cavoairial 0 32 Fr Caval 7 Snares 32 Fr.Caval F Snares ** p<.o1 -lo beating Fibrillated Fibrillated Down Down UP Fig 1. Right ventricular flow rates in 5 dogs during cardiopulmonary bypass using a single atrial (USCI 40F), a single cavoatrial (Sarns 51F), and double caval s (USCl32F) with and without caval tourniquets. (@ = pulmonary artery snare released.) was for the double caval s at mm Hg (Fig 2; see Table). The double caval s and the 51F cavoatrial had identical SVC pressures (1.0 t 1.26 mm Hg). The highest SVC pressure was noted in the single 40F atrial (1.75 & 0.99 mm Hg). With the empty, fibrillated heart of each animal in the down position, the lowest SVC pressure was also in the double caval s (- 3.0? 1.52 mm Hg; see Table). The 40F atrial and 51F cavoatrial had similar SVC pressures (2.17? 0.75 mm Hg and 2.17 t 0.98 mm Hg, respectively). Differences between SVC pressures with the heart beating or fibrillated and elevated in the circumflex position were not statistically significant. The lowest SVC pressure was again noted in the double caval s, while the 40F atrial had the highest SVC pressure (see Table). The SVC pressures for double caval tion were significantly lower (p < 0.05) than those for either single- technique. Although the SVC pressure was lower for the snared s than for the caval s, this variable only became statistically significant when the heart was elevated (p < 0.05). The 40F atrial catheter also
4 62 The Annals of Thoracic Surgery Vol 36 No 1 July 1983 Venous Drainage and Decompression of the Right Side of the Heart with Four Cannulation Techniques (N = 5)" Heart Empty, Heart Heart Heart Beating, Fibrillated, Beating, Fibrillated, Technique Down Down Elevated Elevated RV VENT FLOW^ Single 40F atrial 80 f f Single 51F cavoatrial O t 7 19f 8... can n u 1 a Double 32F caval s 250 t t Double 32F caval s 65 t 20 29f 5... svc PRESSURE' 45 f 8 26 f f 4.5 Single 40F atrial 1.75 t f t i 0.75 Single 51F cavoatrial 1.00? t ? f 0.82 Double 32F caval s f f f t 1.59 Double 32F caval s 1.00 f t f ? 1.25 IVC PRESSURE' Single 40F atrial 4.67 f t f f 2.70 Single 51F cavoatrial -0.50? f t Double 32F caval s f t f f 2.09 Double 32F caval s f t f f 2.56 RA PRESSURE' Single 40F atrial 0.96 f t ? f 1.30 Single 51F cavoatrial f t f f 2.19 Double 32F caval s 5.00 f f f f 2.78 Double 32F caval s 0.60 t ? f f 2.51 RV PRESSURE' Single 40F atrial 3.33 f f f t 1.47 Single 51F cavoatrial f t f f 1.20 Double 32F caval s 5.67 f ? t 1.51 Double 32F caval s 2.13 f f f t 0.89 "Values shown are mean 2 standard deviation. bdata expressed in milliliters per minute. 'Data expressed in millimeters of mercury. RV = right ventricular; SVC = superior vena caval; IVC = inferior vena caval; RA = right atrial.
5 63 Bennett et al: Flow Differences among Venous Cannulas 5 * pc.05 4] rrp< I"I 9) -I I T -4' I I I Beating Fibrillated Beating Fibrillated Dawn Down UP UP Fig 2. Superior vena caval pressures in 5 dogs during cardiopulmona y bypass using a single atrial, a single cavoatrial, and double caval s with and without caval snares. (See Fig 1 for data presentation.) 6 4 P2 E o " Beating Fibrillated Beating Fibrillated Dawn Down UP UP Fig 3. Inferior vena caval pressures in 5 dogs during cardiopulmona y bypass using a single atrial, a single cavoatrial, and double caval s with and without caval snares. (See Fig 1 for data presentation.) showed a significant change in SVC pressure with the heart elevated during fibrillation ( p < 0.05), but none of the other techniques demonstrated significant changes. Inferior Vena Caval Pressure The IVC pressures were consistently higher for the single 40F atrial (Fig 3; see Table). The double caval s had the lowest overall IVC pressures (see Table). However, these pressures were not statistically different from those for the 51F cavoatrial or the double caval s. In addition, IVC pressures with the 40F atrial were significantly higher than those for the other methods (p < 0.05). Right At rial Pressure The 51F cavoatrial consistently had the lowest RA pressures (Fig 4; see Table). The 40F atrial and double caval s without snares had similar values until the heart was fibrillated and elevated in the circumflex position; RA pressures with the 40F were then mm Hg compared with mm Hg for the unsnared double s (p < 0.05). The RA pressures for the double caval s were consistently the highest (see Table), and these measurements were obtained with the pulmonary artery snare released. The snared double caval s showed significantly higher RA pressures than the single 51F cavoatrial ( p < 0.01), the 40F atrial ( p < 0.05), or the double caval s ( p < 0.05). 6 4 m 2 I 0 E Beating Fibrillated Beating Down Down UP 1 Fibrillated UP Fig 4. Right atrial pressures in 5 dogs during cardiopulmonary bypass using a single atrial, a single cavoatrial, and double caval s with and without caval snares. (See Fig 1 for data presentation.) Right Ventricular Pressure The RV pressure was consistently lower for the 51F cavoatrial (Fig 5; see Table). The snared double caval s showed the highest RV pressures (see Table); again, these measurements were taken without the pulmonary artery snare. The double caval s without snares and the 40F atrial had RV pressures that did not differ significantly except when the heart was fibrillated and elevated (11.6 k 0.89 mm Hg versus mm Hg; p < 0.05). This difference is believed to result from less efficient drainage of the coronary sinus flow around the caval catheters when the heart is elevated. With the heart beating, the 51F cavoatrial showed a significantly lower RV pressure than the other techniques (p < 0.05). However,
6 64 The Annals of Thoracic Surgery Vol 36 No 1 July ' -6 Beating Fibrillated Beating Fibrillated Dawn Down UP UP Fig 5. Right ventricular pressures in 5 dogs during cardiopulmonary bypass using a single atrial, a single cavoatrial, and double caval s with and without caval snares. (PA = pulmonary artery; see Fig 1 for data presentation.) when the heart was fibrillated and in the down position, results for the cavoatrial, the 40F atrial, and the double caval s were not significantly different. With the heart fibrillated and elevated, the RV pressure for the double caval s rose almost as high as that for the double s (11.6? 0.89 mm Hg versus 12.5 * 1.51 mm Hg; see Table). Comment Controversy persists concerning which venous drainage system is most effective in decompressing the heart, and under what circumstances. Many manipulative techniques are used during coronary artery surgery for proper exposure of vessels to be grafted, especially the posterior marginal branches of the circumflex coronary artery and the posterior ventricular branches off the right system. In the present report, we have studied the effects of these manipulations on venous drainage and myocardial decompression with different methods of venous drainage and under conditions of high right-sided flow (perfused heart, beating and fibrillated) to test the capabilities of each drainage sytem. Arom and colleagues [2] showed that the amount of blood reaching the right ventricle during anoxic arrest was similarly low for each of several methods, with a range of mlimin to 19 t 5 ml/min. With the 51F cavoatrial in our study, the intraventricular pressure was negative at a ventricular flow of 0 i 7 mlimin. Dur- ing fibrillation the RV pressure was 2.2 t 0.9 mm Hg with a ventricular flow of 19 t 8 ml/ min. The 51F cavoatrial provided the best RA and RV decompression. The double caval s without tapes and the single 40F had equally good results except when the heart was in the circumflex position. With the heart elevated, the double caval s showed a rise in RV pressure that was probably due to restriction of flow around the s that help decompress the heart. The single 40F in the fibrillated circumflex position had an RV pressure not significantly different from that for the 51F cavoatrial but the RA pressure went from mm Hg to mm fig. Decompression of ihe systemic venous circulation, as measured by the SVC and IVC pressures, showed the SVC pressure to be lowest for the double caval s. All of the drainage techniques had SVC pressures less than mm Hg with the heart in physiological position, but with the heart in the circumflex position only the double caval s with and continued to have SVC pressures lower than 2.0 mm Hg (SVC pressures, 2.8? 0.84 mm Hg to 3.0 t 0.82 mm Hg for the 51F cavoatrial and 3.40 * 0.89 mm Hg to 4.3? mm Hg for the 40F atrial ). Inferior vena caval pressures showed uniformly good decompression of the lower venous system under all conditions tested for all techniques except single tion with the 40F atrial, which had IVC pressures significantly higher than those for the other methods. The IVC pressures for the 40F atrial ranged from 4.33? 1.96 mm Hg to mm Hg and showed much variability with the heart in the circumflex position. The IVC pressures for the other methods were not changed significantly by placing the heart in the circumflex position. In 1. summary: Double caval s provide maximum venous (decompression, especially of the superior venia cava. Decompression of
7 65 Bennett et al: Flow Differences among Venous Cannulas the right side of the heart is passive and in the heart being perfused requires venting of the right atrium by release of tapes or atrial suction. 2. Double caval s provide good and consistent venous and atrial decompression. The ventricle is decompressed well except when the perfused heart is in the circumflex position. 3. A large single (e.g., USCI 40F) can decompress both the venous system and right side of the heart, although venous and atrial drainage are much less efficient when the heart is in the circumflex position. 4. The Sarns 51F cavoatrial decompressed the venous system as efficiently as the double caval s. In fact, decompression of the atrium and ventricle were consistently much better with the cavoatrial than with any of the other methods. 5. Efficient venous and myocardial decompression using the 51F cavoatrial requires the atrial drainage ports to be positioned in the upper middle section of the atrium. Clinically, the position is correct when both the single and double marking bands on the are outside the atrium. References 1. Miller DW, Ivey TD, Bailey WW, et al: The practice of coronary artery bypass surgery in J Thorac Cardiovasc Surg 81:423, Arom KV, Ellestad C, Grover FL, Trinkle JK: Objective evaluation of the efficacy of various venous s. J Thorac Cardiovasc Surg 81:464, 1981
Heart transplantation is the gold standard treatment for
Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but
More informationExperience with Ross Basket Device for Single Right Atrial Venous Cannulation in Coronary Artery Bypass Graft Surgery
ORIGINAL ARTICLE ABSTRACT Experience with Ross Basket Device for Single Right Atrial Venous Cannulation in Coronary Artery Bypass Graft Surgery Syed Asadullah Hussaini, Mubashir Ahmed Objective Study design
More informationPartial anomalous pulmonary venous connection to superior
Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava The Warden Procedure Robert A. Gustafson, MD Partial anomalous pulmonary venous connection
More informationThe Cardiovascular System
The Cardiovascular System The Manila Times College of Subic Prepared by: Stevens B. Badar, RN, MANc THE HEART Anatomy of the Heart Location and Size approx. the size of a person s fist, hollow and cone-shaped,
More informationCite this article as:
doi: 10.21037/acs.2018.08.06 Cite this article as: Loforte A, Baiocchi M, Gliozzi G, Coppola G, Di Bartolomeo R, Lorusso R. Percutaneous pulmonary artery venting via jugular vein while on peripheral extracorporeal
More informationCh.15 Cardiovascular System Pgs {15-12} {15-13}
Ch.15 Cardiovascular System Pgs {15-12} {15-13} E. Skeleton of the Heart 1. The skeleton of the heart is composed of rings of dense connective tissue and other masses of connective tissue in the interventricular
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationCardiac tumors are unusual and cardiac malignancy, usually
Cardiac Autotransplantation Shanda H. Blackmon, MD,* and Michael J. Reardon, MD Cardiac tumors are unusual and cardiac malignancy, usually sarcoma, is a very small subset of these. The literature on cardiac
More informationWHILE it is generally agreed that elevation
The Derivation of Coronary Sinus Flow During Elevation of Right Ventricular Pressure By HERMAN M. GELLER, B.S., M.D., MARTIN BRANDFONBRENEU, M.D., AND CARL J. WIGGERS, M.D., The derivation of coronary
More informationThe Heart. The Heart A muscular double pump. The Pulmonary and Systemic Circuits
C H A P T E R 19 The Heart The Heart A muscular double pump circuit takes blood to and from the lungs Systemic circuit vessels transport blood to and from body tissues Atria receive blood from the pulmonary
More informationMechanisms determining the behaviour of the left atrial pressure during cardioplegia
Thorax (1966), 21, 551. Mechanisms determining the behaviour of the left atrial pressure during cardioplegia J. BRUCE JOHNSTON, G. R. PRTCHARD, AND J. S. WRGHT' From the Department of Cardiopulmonary Surgery,
More informationPearson's Comprehensive Medical Assisting Administrative and Clinical Competencies
Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies THIRD EDITION CHAPTER 27 The Cardiovascular System Lesson 1: Overview of the Cardiovascular System Lesson Objectives Upon
More informationCardiovascular System. Heart Anatomy
Cardiovascular System Heart Anatomy 1 The Heart Location & general description: Atria vs. ventricles Pulmonary vs. systemic circulation Coverings Walls The heart is found in the mediastinum, the medial
More informationPrepared Pulmonary venous Orifice
HOW TO DO IT The Surgical Technique of Heterotopic Heart Transplantation D. Novitzky, M.D., F.C.S.(S.A.), D. K. C. Cooper, M.A., M.B., B.S., Ph.D., F.R.C.S., and C. N. Barnard, M.D., M.Med., M.S., Ph.D.,
More informationThe management of chronic thromboembolic pulmonary
Technique of Pulmonary Thromboendarterectomy Isabelle Opitz, MD, and Marc de Perrot, MD, MSc, FRCSC Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, Ontario, Canada. Address reprint
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationSaphenous Vein Autograft Replacement
Saphenous Vein Autograft Replacement of Severe Segmental Coronary Artery Occlusion Operative Technique Rene G. Favaloro, M.D. D irect operation on the coronary artery has been performed in 180 patients
More informationThis lab activity is aligned with Visible Body s A&P app. Learn more at visiblebody.com/professors
1 This lab activity is aligned with Visible Body s A&P app. Learn more at visiblebody.com/professors 2 PRE-LAB EXERCISES: A. Watch the video 29.1 Heart Overview and make the following observations: 1.
More informationPerfusion for Repair of Aneurysms of the Transverse Aortic Arch
technique This new section is open for technicians to explore the unusual, the difficult, the innovative methods by which perfusion meets the challenge of the hour and produces the ultimate goal - a life
More informationInteresting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart. O Wenker, L Chaloupka, R Joswiak, D Thakar, C Wood, G Walsh
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 3 Number 2 Interesting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart O Wenker, L Chaloupka, R
More informationLarge veins of the thorax Brachiocephalic veins
Large veins of the thorax Brachiocephalic veins Right brachiocephalic vein: formed at the root of the neck by the union of the right subclavian & the right internal jugular veins. Left brachiocephalic
More informationSURGERY INTERNATIONAL ABSTRACTS OF SURGERY WITH VOLUME 109 NUMBER 1
SURGERY WITH INTERNATIONAL ABSTRACTS OF SURGERY VOLUME 109 NUMBER 1 SELECTIVE HYPOTHERMIA OF THE HEART IN ANOXIC CARDIAC ARREST NORMAN E. SHUMWAY, M. D., RICHARD R. LOWER, M. D., and RAYMOND C. STOFER,
More informationFurther Studies on the Effect of Arteriovenous Fistulas and Elevations of Sinus Pressure
Further Studies on the Effect of Arteriovenous Fistulas and Elevations of Sinus Pressure on Mortality Rates Following Acute Coronary Occlusions By GEORGE SMITH, F.R.C.S., JAMES DEMMING, MORTON ELEFF, AND
More informationExtracorporeal life support (ECLS) supplements the
CARDIOPULMONARY SUPPORT AND PHYSIOLOGY A PROSPECTIVE COMPARISON OF ATRIO-FEMORAL AND FEMORO-ATRIAL FLOW IN ADULT VENOVENOUS EXTRACORPOREAL LIFE SUPPORT Preston B. Rich, MD Samir S. Awad, MD Stefania Crotti,
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More information2. right heart = pulmonary pump takes blood to lungs to pick up oxygen and get rid of carbon dioxide
A. location in thorax, in inferior mediastinum posterior to sternum medial to lungs superior to diaphragm anterior to vertebrae orientation - oblique apex points down and to the left 2/3 of mass on left
More informationThe pericardial sac is composed of the outer fibrous pericardium
Pericardiectomy for Constrictive or Recurrent Inflammatory Pericarditis Mauricio A. Villavicencio, MD, Joseph A. Dearani, MD, and Thoralf M. Sundt, III, MD Anatomy and Preoperative Considerations The pericardial
More informationMechanical Bleeding Complications During Heart Surgery
Mechanical Bleeding Complications During Heart Surgery Arthur C. Beall, Jr., M.D., Kenneth L. Mattox, M.D., Mary Martin, R.N., C.C.P., Bonnie Cromack, C.C.P., and Gary Cornelius, C.C.P. * Potential for
More informationTHE CARDIOVASCULAR SYSTEM. Part 1
THE CARDIOVASCULAR SYSTEM Part 1 CARDIOVASCULAR SYSTEM Blood Heart Blood vessels What is the function of this system? What other systems does it affect? CARDIOVASCULAR SYSTEM Functions Transport gases,
More informationAnatomy of the Heart
Biology 212: Anatomy and Physiology II Anatomy of the Heart References: Saladin, KS: Anatomy and Physiology, The Unity of Form and Function 8 th (2018). Required reading before beginning this lab: Chapter
More informationECLS as Bridge to Transplant
ECLS as Bridge to Transplant Marcelo Cypel MD, MSc Assistant Professor of Surgery Division of Thoracic Surgery Toronto General Hospital University of Toronto Application of ECLS Bridge to lung recovery
More informationEbstein s anomaly is defined by a downward displacement
Repair of Ebstein s Anomaly Sylvain Chauvaud, MD Ebstein s anomaly is a tricuspid valve anomaly associated with poor right ventricular contractility in severe cases. Surgery is indicated in all symptomatic
More informationAugust, 2015 STATE MEDICAL FACULTY OF WEST BENGAL. Preliminary Examinations for Diploma in Perfusion Technology : DPfT. Paper I ANATOMY & PHYSIOLOGY
August, 2015 STATE MEDICAL FACULTY OF WEST BENGAL Paper I ANATOMY & PHYSIOLOGY Time 3 hours Full Marks 80 Group A Q-1) Write the correct Answer: 10x1 = 10 i) The posterior descending artery is branch of
More informationHuman Anatomy, First Edition
Human Anatomy, First Edition McKinley & O'Loughlin Chapter 22 : Heart 1 Functions of the Heart Center of the cardiovascular system, the heart. Connects to blood vessels that transport blood between the
More information11/10/2014. Muscular pump Two atria Two ventricles. In mediastinum of thoracic cavity 2/3 of heart's mass lies left of midline of sternum
It beats over 100,000 times a day to pump over 1,800 gallons of blood per day through over 60,000 miles of blood vessels. During the average lifetime, the heart pumps nearly 3 billion times, delivering
More informationThe Mammalian Circulatory System
The Mammalian Heart The Mammalian Circulatory System Recall: What are the 3 cycles of the mammalian circulatory system? What are their functions? What are the three main vessel types in the mammalian circulatory
More informationClinical Applications of Femoral Vein-to-Artery Cannulation for Mechanical Cardiopulmonary Support and Bypass
Clinical Applications of Femoral Vein-to-Artery Cannulation for Mechanical Cardiopulmonary Support and Bypass Robert L. Berger, M.D., Virender K. Saini, M.D., and Everett L. Dargan, M.D. ABSTRACT Femoral
More informationTHE VESSELS OF BLOOD CIRCULATION
THE VESSELS OF BLOOD CIRCULATION scientistcindy.com /the-vessels-of-blood-circulation.html NOTE: You should familiarize yourself with the anatomy of the heart and have a good understanding of the flow
More informationFigure ) The specific chamber of the heart that is indicated by letter A is called the. Diff: 1 Page Ref: 364
Essentials of Anatomy and Physiology, 9e (Marieb) Chapter 11 The Cardiovascular System Short Answer Figure 11.1 Using Figure 11.1, identify the following: 1) The Purkinje fibers are indicated by label.
More informationExam 3 Study Guide. 4) The process whereby the binding of antibodies to antigens causes RBCs to clump is called:
Exam 3 Study Guide 1) Where does hematopoiesis produce new red blood cells: 2) Which of the following is a blood clotting disorder: 3) Treatment of hemophilia often involves: 4) The process whereby the
More informationChapter 20 (1) The Heart
Chapter 20 (1) The Heart Learning Objectives Describe the location and structure of the heart Describe the path of a drop of blood from the superior vena cava or inferior vena cava through the heart out
More informationThe HEART. What is it???? Pericardium. Heart Facts. This muscle never stops working It works when you are asleep
This muscle never stops working It works when you are asleep The HEART It works when you eat It really works when you exercise. What is it???? Located between the lungs in the mid thoracic region Apex
More informationCV Anatomy Quiz. Dr Ella Kim Dr Pip Green
CV Anatomy Quiz Dr Ella Kim Dr Pip Green Q1 The location of the heart is correctly described as A) lateral to the lungs. B) medial to the sternum. C) superior to the diaphragm. D) posterior to the spinal
More informationMechanics of Cath Lab Support Devices
Mechanics of Cath Lab Support Devices Issam D. Moussa, MD Chief Medical Officer First Coast Cardiovascular Institute, Jacksonville, FL Professor of Medicine, UCF, Orlando, FL None DISCLOSURE Percutaneous
More informationNOTES. Left-Sided Cannulation of the Right. Atrium for Mitral Surgery. Ronald P. Grunwald, M.D., A. Attai-Lari, M.D., and George Robinson, M.D.
NOTES Left-Sided Cannulation of the Right Atrium for Mitral Surgery Ronald P. Grunwald, M.D., A. Attai-Lari, M.D., and George Robinson, M.D. T here are several approaches to the mitral valve which yield
More informationExpanding Horizons: AngioVac Suction Thrombectomy at UTHealth
Expanding Horizons: AngioVac Suction Thrombectomy at UTHealth Naveed Saqib, MD Assistant Professor Department of Cardiothoracic and Vascular Surgery McGovern Medical School The University of Texas Science
More informationThe Cardiovascular System (Heart)
The Cardiovascular System The Cardiovascular System (Heart) A closed system of the heart and blood vessels The heart pumps blood Blood vessels allow blood to circulate to all parts of the body The function
More informationThe Cardiovascular System. Chapter 15. Cardiovascular System FYI. Cardiology Closed systemof the heart & blood vessels. Functions
Chapter 15 Cardiovascular System FYI The heart pumps 7,000 liters (4000 gallons) of blood through the body each day The heart contracts 2.5 billion times in an avg. lifetime The heart & all blood vessels
More informationThe Cardiovascular System
Essentials of Human Anatomy & Physiology Elaine N. Marieb Slides 11.1 11.19 Seventh Edition Chapter 11 The Cardiovascular System Functions of the Cardiovascular system Function of the heart: to pump blood
More informationIdentify the lines used in anatomical surface descriptions of the thorax. median line mid-axillary line mid-clavicular line
L 14 A B O R A T O R Y Thorax THORACIC WALL Identify the lines used in anatomical surface descriptions of the thorax. median line mid-axillary line mid-clavicular line Identify the surface landmarks of
More informationUnderstanding the Cardiopulmonary Bypass Machine and Its Tubing
Understanding the Cardiopulmonary Bypass Machine and Its Tubing Robert S. Leckie, MD Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center ABL 1/09 Reservoir Bucket This is a cartoon of
More informationCollin County Community College. ! BIOL Anatomy & Physiology! WEEK 5. The Heart
Collin County Community College! BIOL. 2402 Anatomy & Physiology! WEEK 5 The Heart 1 (1578-1657) A groundbreaking work in the history of medicine, English physician William Harvey s Anatomical Essay on
More informationIndications. The AngioVac cannula is intended for use as a venous drainage cannula and for the removal of fresh, soft thrombi or emboli
Indications Straight Cannula or Cannula with 20 O Angle 17F Working Channel The AngioVac cannula is intended for use as a venous drainage cannula and for the removal of fresh, soft thrombi or emboli Radiopaque
More informationMinimal access aortic valve surgery has become one of
Minimal Access Aortic Valve Surgery Through an Upper Hemisternotomy Approach Prem S. Shekar, MD Minimal access aortic valve surgery has become one of the accepted forms of surgical therapy for patients
More information4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium.
Answer each statement true or false. If the statement is false, change the underlined word to make it true. 1. The heart is located approximately between the second and fifth ribs and posterior to the
More informationAP2 Lab 3 Coronary Vessels, Valves, Sounds, and Dissection
AP2 Lab 3 Coronary Vessels, Valves, Sounds, and Dissection Project 1 - BLOOD Supply to the Myocardium (Figs. 18.5 &18.10) The myocardium is not nourished by the blood while it is being pumped through the
More informationPenetrating wounds of the heart and great vessels
Thorax (1973), 28, 142. Penetrating wounds of the heart and great vessels A report of 30 patients C. E. ANAGNOSTOPOULOS and C. FREDERICK KITTLE Department of Surgery, Section of Thoracic and Cardiovascular
More informationI worldwide [ 11. The overall number of transplantations
Expanding Applicability of Transplantation After Multiple Prior Palliative Procedures Alan H. Menkis, MD, F. Neil McKenzie, MD, Richard J. Novick, MD, William J. Kostuk, MD, Peter W. Pflugfelder, MD, Martin
More informationthe Cardiovascular System I
the Cardiovascular System I By: Dr. Nabil A Khouri MD, MsC, Ph.D MEDIASTINUM 1. Superior Mediastinum 2. inferior Mediastinum Anterior mediastinum. Middle mediastinum. Posterior mediastinum Anatomy of
More informationMitral valve infective endocarditis (IE) is the most
Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction Gregory J. Bittle, MD, Murtaza Y. Dawood, MD, and James S. Gammie, MD Mitral valve infective endocarditis
More informationHUMAN HEART. Learn the following structures on the heart models.
HUMAN HEART Learn the following structures on the heart models. The human heart has four chambers that consist of the right atrium, left atrium, right ventricle, and left ventricle. The atria are smaller
More informationand of Kasr-el-Aini, Cairo, Egypt (Received 10 November 1952) METHODS
419 J. Physiol. (I953) I20, 49-426 RELEASE OF HISTAMINE BY THE LIVER BY G. V. ANREP, G. S. BARSOUM AND M. TALAAT From the Physiological Laboratories, Medical Faculties of Alexandria and of Kasr-el-Aini,
More informationLines and tubes. 1 Nasogastric tubes Endotracheal tubes Central lines Permanent pacemakers Chest drains...
Lines and tubes 1 Nasogastric tubes... 15 2 Endotracheal tubes.... 19 3 Central lines... 21 4 Permanent pacemakers.... 25 5 Chest drains... 30 This page intentionally left blank 1 Nasogastric tubes Background
More informationMechanics of Cath Lab Support Devices
Mechanics of Cath Lab Support Devices Issam D. Moussa, MD Professor of Medicine Mayo Clinic College of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, Florida DISCLOSURE Presenter:
More informationCitation Acta medica Nagasakiensia. 1984, 29
NAOSITE: Nagasaki University's Ac Title Author(s) Efficacy of Coenzyme Q10 Administra Aortic Stenosis and Pacemaker Induc Igarashi, Katsuro Citation Acta medica Nagasakiensia. 1984, 29 Issue Date 1984-10-25
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationChapter 14. The Cardiovascular System
Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2
More informationThinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease
Thinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease Shane Buel MS, RRT 1 Nicole Michaud MS CCP PBMT 1 Rashid Ahmad MD 2 1 Vanderbilt
More informationThe Role of ECMO in Thoracic Surgery. Matthew Hartwig, MD
The Role of ECMO in Thoracic Surgery Matthew Hartwig, MD Disclosure Slide Consultant for Mallincrodkt and Quark Pharmaceuticals Case #1 28 y.o. female with tracheal mass No previous medical or surgical
More informationCJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1. Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book)
CJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1 Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book) Introduction When you have finished examining the model, you are ready to begin your
More informationTHE HEART OBJECTIVES: LOCATION OF THE HEART IN THE THORACIC CAVITY CARDIOVASCULAR SYSTEM
BIOLOGY II CARDIOVASCULAR SYSTEM ACTIVITY #3 NAME DATE HOUR THE HEART OBJECTIVES: Describe the anatomy of the heart and identify and give the functions of all parts. (pp. 356 363) Trace the flow of blood
More informationRegional Venous Drainage of the Human Heart*
Brit. HeartyJ., 1968, 30, 105. Regional Venous Drainage of the Human Heart* WILLIAM B. HOOD, JR.t From the Cardiac Department, St. Thomas's Hospital, London, S.E.1 Blood samples obtained from the coronary
More informationAn anterior aortoventriculoplasty, known as the Konno-
The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,
More informationT delivery to the myocardium through the coronary
Facile Retrograde Cardioplegia: Transatrial Cannulation of the Coronary Sinus Steven R. Gundry, MD, Alexandro Sequiera, MD, Anees M. Razzouk, MD, Joseph S. McLaughlin, MD, and Leonard L. Bailey, MD Divisions
More informationTitle: Total Aortic Arch Replacement under Intermittent Pressure-augmented Retrograde Cerebral Perfusion
Author's response to reviews Title: Total Aortic Arch Replacement under Intermittent Pressure-augmented Authors: Hiroshi Kubota (kub@ks.kyorin-u.ac.jp) Kunihiko Tonari (ktonari@ks.kyorin-u.ac.jp) Hidehito
More information10/23/2017. Muscular pump Two atria Two ventricles. In mediastinum of thoracic cavity 2/3 of heart's mass lies left of midline of sternum
It beats over 100,000 times a day to pump over 1,800 gallons of blood per day through over 60,000 miles of blood vessels. During the average lifetime, the heart pumps nearly 3 billion times, delivering
More informationMODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION
MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION II. Surgical technique of the maze III procedure The operative technique of the maze III procedure for the treatment of patients
More informationAcute type A aortic dissection (Type I, proximal, ascending)
Acute Type A Aortic Dissection R. Morton Bolman, III, MD Acute type A aortic dissection (Type I, proximal, ascending) is a true surgical emergency. It is estimated that patients suffering this calamity
More information10/14/2018 Dr. Shatarat
2018 Objectives To discuss mediastina and its boundaries To discuss and explain the contents of the superior mediastinum To describe the great veins of the superior mediastinum To describe the Arch of
More informationCardiovascular system:
Cardiovascular system: Mediastinum: The mediastinum: lies between the right and left pleura and lungs. It extends from the sternum in front to the vertebral column behind, and from the root of the neck
More informationVESSELS: GROSS ANATOMY
ACTIVITY 10: VESSELS AND CIRCULATION OBJECTIVES: 1) How to get ready: Read Chapter 23, McKinley et al., Human Anatomy, 4e. All text references are for this textbook. 2) Observe and sketch histology slide
More informationhuman anatomy 2016 lecture thirteen Dr meethak ali ahmed neurosurgeon
Heart The heart is a hollow muscular organ that is somewhat pyramid shaped and lies within the pericardium in the mediastinum. It is connected at its base to the great blood vessels but otherwise lies
More informationThe evolution of the Fontan procedure for single ventricle
Hemi-Fontan Procedure Thomas L. Spray, MD The evolution of the Fontan procedure for single ventricle cardiac malformations has included the development of several surgical modifications that appear to
More informationT O PROVIDE circulatory arrest in the
Profound Selective Hypothermia and Arrest of Arterial Circulation to the Dog Brain* JAVIER VERDURA, M.D., ROBERT J. WHITE, M.D., PH.D., AND IM:AURICE S. ALBIN, M.D., M.Sc. Section of Neurosurgery, Cleveland
More informationHemodynamic Monitoring
Perform Procedure And Interpret Results Hemodynamic Monitoring Tracheal Tube Cuff Pressure Dean R. Hess PhD RRT FAARC Hemodynamic Monitoring Cardiac Rate and Rhythm Arterial Blood Pressure Central Venous
More informationLesson 10 Circulatory System (Nelson p.88-93)
Name: Date: Lesson 10 Circulatory System (Nelson p.88-93) Learning Goals: A. I can explain the primary functions of the circulatory system in animals. B. I can identify and explain all the parts of the
More informationConcomitant procedures using minimally access
Surgical Technique on Cardiac Surgery Concomitant procedures using minimally access Nelson Santos Paulo Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Oporto, Portugal Correspondence to:
More informationAnatomy of the Heart. Figure 20 2c
Anatomy of the Heart Figure 20 2c Pericardium & Myocardium Remember, the heart sits in it s own cavity, known as the mediastinum. The heart is surrounded by the Pericardium, a double lining of the pericardial
More informationLecture 2: Clinical anatomy of thoracic cage and cavity II
Lecture 2: Clinical anatomy of thoracic cage and cavity II Dr. Rehan Asad At the end of this session, the student should be able to: Identify and discuss clinical anatomy of mediastinum such as its deflection,
More informationof Potassium ~ardiopbgic Solution
Comparison of Roller Pump versus Pressurized Bag Administration of Potassium ~ardiopbgic Solution Frederick L. Grover, M.D., John G. Fewel, M.S., John J. Ghidoni, M.D., Edward V. Bennett, Jr., M.D., and
More informationYour heart is a muscular pump about the size of your fist, located
How Your Heart Works Your heart is a muscular pump about the size of your fist, located slightly to the left and behind your breastbone. Its function is to pump blood throughout your body. As your heart
More informationDistribution and Responses of the Cardiac Sympathetic Receptors to Mechanically Induced Circulatory Changes
Distribution and Responses of the Cardiac Sympathetic Receptors to Mechanically Induced Circulatory Changes Hideo UEDA, M.D., Yasumi UCHIDA, M.D., and Kazuaki KAMISAKA, M.D. SUMMARY Distribution and mode
More informationOXYGEN CONSUMPTION' JREISSATY, AND JIRO NAKANO 4. cannula was introduced via the left external jugular vein
EFFECT OF AORTIC INSUFFICIENCY ON ARTERIAL BLOOD PRESSURE, CORONARY BLOOD FLOW AND CARDIAC OXYGEN CONSUMPTION' By RENE WEGRIA, GERHARD MUELHEIMS,2 JAMES GOLUB,3 ROBERT JREISSATY, AND JIRO NAKANO 4 (From
More informationLung cancer or primary malignant tumors of the mediastinum
Technique of Superior Vena Cava Resection for Lung Carcinomas David R. Jones, MD Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville,
More informationACTIVITY 9: BLOOD AND HEART BLOOD
ACTIVITY 9: BLOOD AND HEART OBJECTIVES: 1) How to get ready: Read Chapters 21 & 22, McKinley et al., Human Anatomy, 4e. All text references are for this textbook. Read dissection instructions BEFORE YOU
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationThe Cardiovascular System
PowerPoint Lecture Slide Presentation by Patty Bostwick-Taylor, Florence-Darlington Technical College The Cardiovascular System 11PART B The Heart: Cardiac Output Cardiac output (CO) Amount of blood pumped
More informationVocabulary. Heart attack- התקף לב (hetkef lev)
Vocabulary Cardiovascular (CV) System- מערכת לב וכלי דם (ma arechet lev v klay dahm) Blood- דם (dahm) Blood vessels- כלי דם (klay dahm) Artery/Arteries- עורק/ עורקים (ohrek/ohrakeem) Vein/Veins- וריד/ורידים
More informationIntroduction to Anatomy. Dr. Maher Hadidi. Bayan Yanes. April/9 th /2013
Introduction to Anatomy Dr. Maher Hadidi Bayan Yanes 27 April/9 th /2013 KEY POINTS: 1) Right side of the heart 2) Papillary muscles 3) Left side of the heart 4) Comparison between right and left sides
More information