By Ludwig K. von Segesser M.D., F.A.C.S. (auth.)
With an enormous historical past of non-public adventure and a evaluation of greater than three hundred references, Dr. Segesser has written a publication to shut the distance among the idea and perform of coronary artery revascularization. particularly, he indicates the probabilities and barriers of inner mammary artery grafting during this surgery. The chapters advisor you to a radical figuring out of the topic, from anatomy and pathology, to experimental reports and the historical past of first surgical makes an attempt, to scientific program and effects. The dialogue of long term follow-up, problems and re-operations element to parts of luck in addition to topics for destiny study. the main points supplied the following approximately operative thoughts and their results provide the cardiovascular surgical workforce very important suggestions approximately current practices on the way to support result in better medical effects.
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Extra info for Arterial Grafting for Myocardial Revascularization: Indications, Surgical Techniques and Results
8). The main indication for retrointernal mammary artery~coro nary artery anastomoses might be patients with severely diseased ascending aorta and 37 supraaortic vessels in combination with relatively distal coronary artery lesions. In consideration of the reduced flow of the retrointernal mammary arteries in comparison to the anterointernal mammary arteries, as many collaterals as possible have to be preserved during the harvesting procedure in order to supply adequate flow (von Segesser et al.
Routine angiography of the subclavian arteries and the internal mammary arteries during coronary catheterization appears to be a useful tool for preoperative evaluation of these vessels. 22 4 Pathology of the Internal Mammary Artery and the Subclavian Artery Fig. 23. Microscopic view of an internal mammary artery section with luminal narrowing of 15 % due to intimal hyperplasia (van Gieson) Fig. 24. 1 Normal Internal Mammary Artery Flow Internal mammary artery flow studies had already been performed at the time of Vineberg's operation when the internal mammary artery was implanted into the myocardium (Blesovsky et al.
There can be no doubt about substantial backflow through the distal collaterals of the internal mammary arteries in humans as probably all surgeons performing internal mammary-coronary artery anastomoses have some experience with persistent bleeding originating from these collaterals. However, the free flow of the human retrointernal mammary artery measured by Goiti et al. (1982) was only 40 ml/min and Livi et al. (1986) reported 60 ml/min. These figures account for a mean retrointernal mammary artery flow of 50 ml/min or only 36 % of the 138 ml/min reported by Green (1971) as mean free flow for anterointernal mammary arteries in humans.
Arterial Grafting for Myocardial Revascularization: Indications, Surgical Techniques and Results by Ludwig K. von Segesser M.D., F.A.C.S. (auth.)