POEM BY NARI CARDIAC D-I-Y

Poem by Nari
visual poetry from the cyberstream

CARDIAC
D-I-Y
-
self
guide
to
cardiac
surgery

Tired ticker?

Concerned
by
high cost
professional
medical services?

Low cost
self serve
heart surgery
is here!

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with
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easy to use
self help
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Operative Technique tportsiteandimmediatelyweighed.Theremaininglungisnothandledd dtowatersealtolimittheairleak.Patientsareextubatedintheopera saredividedwithelectrocautery.Thelungresectionisstartedusing rnotomy,aswellasanterior/lateralthoracotomyonbothsides.Thesh positedirection.Thecontralaterallungiscollapsedandmirror-ima edbyplacementofpillows.Inflatablebagsareplacedlongitudinally ytothethorax.Afterthoracoscopicinspectionofthelung,additiona ementconfigurationallowsforelectrocauterydivisionofadhesions ustechniquewithavoidanceofdirecttissuehandlingisemployedtopr gthealreadydividedlungforretractionandtopositionthestaplingd entsareintubatedwithaleft-sideddouble-lumenendotrachealtubef icepiduralcatheterisplacedatthefourthtofifththoracicvertebra optimalbodypositioningduringtheprocedure.Theskinispreparedfr t.Paul,MN).Properstaplerplacementisverifiedfrombothsidesbefo layers.Theinflatablebagundertheoperativesideisdeflatedandthe placedunderdirectvision.Ontheleftsidetheheartoffersminimalob llevelwhilethepatientisawake.Afterinductionofanesthesia,pati thesecondside.Attheconclusionoftheprocedurea1.5-cmincisionan extendedoverthehead(Fig1).Theshouldersandupperarmsareprotect ssageofthestaplingdevicethroughalargerintercostalspace,witha oppositeside'sbaginflatedwiththeoperatingtablerotatedtotheop underthescapulaeoneachsidetobeinflatedbytheanesthesiateamfor lportsareplacedanteriorlyatthelevelofthediaphragm,allowingpa uringtheproceduretominimizeairleaks.Twoapicallydirectedchest sresectedfromeachside.Thespecimenisretrievedthroughthelarges edtowardtheoppositeside.Thebronchialtubeisthenclampedandthel ativeairleak.Subsequentexcisionsareperformedincontinuityusin evice.Ahorseshoe-shapedspecimenisremovedfromthesuperiorporti tubesareplacedunderdirectvisionthroughthelowerportsandsecure Patientsareadmittedthedayoftheoperation,andaradiopaquethorac omchintoumbilicusandlaterallytotheposterioraxillaryline.This ungallowedtodeflate.Thefirstthoracoscopicportisplacedanterio eproximalpericardialstripisremovedusingaKocherclamp.Fastidio structiontointrumentmanipulation.Thelungexcisionisrepeatedon retheinstrumentisfired.Thepolypropylenesutureatthecutendofth beropticbronchoscopy.Patientsarepositionedsupinewithbotharms anEndopath45(EthiconEndo-Surgery,Cincinnati,OH),asintheopent neisreinforcedwithbovinepericardialstrips(Bio-Vascular,Inc,S positionofferssatisfactoryexposurefornotonlyVATSbutmedianste oulderbagontheinitialoperativesideisinflatedandthetablerotat attheapexandposteriorlywithoutsignificantdifficulty.Adhesion dtwochesttubesarepresentoneachside.Thoracostomytubesareplace orlungseparation.Thepositionofthebronchialtubeisverifiedbyfi rlyatthesubmammarylevel.Perfecthemostasisisensuredduringentr thirdportlaterallyatthelevelofthesubmammaryline.Thisportplac echnique,attheanteriorborderoftheupperlung(Fig2).Thestapleli geincisionsareplacedforentrytothepleuralcavity.Portsareagain onofthelung,asintheopentechnique.Anaverageof80goflungtissuei eventdamagetofriablelungtissuewithitsattendantriskofpostoper dtotheskin.Thelungisallowedtoexpandslowlyandthewoundclosedin and transferred to the recovery area.

THE SOCIETY OF
THORACIC SURGEONS

I L L U S T R A T E D
HOW TO DO IT!

The Annals of
Thoracic Surgery

ATS VOLUME 63
NUMBER 6
JUNE 1997

FACILITATED EXPOSURE OF THE INTERNAL MAMMARY ARTERY
IN MINIMALLY INVASIVE DIRECT-VISION CABG

Erik W. L. Jansen, MD, Hendricus J. Mansvelt Beck,
Paul F. Gründeman, MD, PhD, and Johan J. Bredée, MD, PhD
Invited Commentary: M. Clive Robinson, MD

CORRECTION OF LEFT SUPERIOR VENA CAVA DRAINING
TO THE LEFT ATRIUM USING EXTRACARDIAC TECHNIQUES

V. Mohan Reddy, MD, Doff B. McElhinney, MS,
and Frank L. Hanley, MD

ALTERNATIVE TECHNIQUE FOR THE OSTIUM PRIMUM DEFECT REPAIR:
A FREE WALL FLAP OF RIGHT ATRIUM

Massimo Massetti, MD, Gerard Babatasi, MD, Eugenio Neri, MD,
and Andre Khayat, MD

LINEAR SEGMENTAL ANNULOPLASTY FOR MITRAL VALVE REPAIR

Alessandro Ricchi, MD, Paolo Ortu, MD, Emiliano M. Cirio, MD,
Susanna Falchi, MD, Giovanni Lixi, MD, and Valentino Martelli, MD

SINGLE-STAGE BILATERAL, VIDEO-ASSISTED
THORACOSCOPIC LUNG VOLUME REDUCTION OPERATION

Wickii T. Vigneswaran, MD, and Francis J. Podbielski, MD

RELATED
INFORMATION

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