Journal of Cardiothoracic Surgery - Latest Comments

Reservations on SAC

A Protopapas — 2008-08-29T00:00:00Z

Just a quick comment: cannulating the innominate artery does nothing to prevent cardiac injury upon re-entry, it just offers an option for the aortic pipe IN CASE OF CARDIAC INJURY-we still have to divide the sternum and mostly introduce bicaval cannulae.

I do not see how access for cannulation via the suprasternal notch is safer than redo sternotomy-the tissues are already adhered given the previous sternotomy, particularly where thymectomy and innominate cannulation have taken place in the first operation.The same applies to cavoatrial cannulation without sternotomy-a video showing the technique would be illuminating!

Kindest Regards

Aristotle D Protopapas MSc. FRCS

See a pubcast of this article at SciVee!

Lynn Fink — 2008-08-29T00:00:00Z

Link to a video of this article.

LAM is a real possibility

Ben Creagh-Brown — 2007-01-23T00:00:00Z

Dear Sirs,

I read your case with great interest. I have recent published a case of recurrent pneumothorax during pregnancy where the underlying diagnosis was LAM (Creagh-Brown B, Cooke N, Corbishley C, Conservative management of an unusual cause of breathlessness during pregnancy. Respiratory Medicine Extra (2006) 2, 116–119)

You mention the possibility that LAM may underlie your patient's presentations but do not explain what investigations have taken place to exclude this possibility. It would be reassuring to know that her pulmonary function tests and HRCT were normal.

Yours sincerely, Ben

Alternative single stage approach for dealing with CoA and associated cardiac disease.

jagannath byalal — 2006-07-28T00:00:00Z

I read with great interest the article detailing the use of sternotomy, TCA and extranatomic conduit for bypassing the coarcted segment. It indeed is an excellent palliation in the sense that it still uses a conduit, needs TCA which certainly is not totally benign and the conduit lie, position and length must be carefully adjusted so that compression by the cardiac mass does not occur.

We had a patient recently who was 50 yrs old, had severe calcific aortic stenosis and a very tight coarctation.

I elected to do both at a single sitting using a transverse sternotomy with a left thoracotomy extended onto the right side a little bit. In this particular instance I opened the right pleura but I believe that the same could be done without opening the pleura on the right side.

The access to the coarct segment was very good, I did a resection end to end anastomosis and followed with an aortic valve replacement in the usual fashion.

The patient did very well and is ready for discharge.

The only disadvantage is that the IMA on both sides may have to be sacrificed, however if concomitant grafting is needed then it can easily be harvested and used.

Moreover the access to the arch vessels is excellent and can be repaired .

So although the sternotomy approach with a extraanatomic graft may be a viable alternative I prefer to use the thoracotomy,transverse sternotomy approach.