What are the Technique of Operation Cardiovascular Surgery?
Technique of Operation Cardiovascular Surgery : The operation is done on cardiopulmonary bypass with profound hypothermia and period of circulatory arrest. The superior vena cava is dissected upto the innominate vein and taped for retraction to help exposure of the right pulmonary artery upto the hilum. Aortic, SVC, IVC cannulae are inserted for bypass. A vent catheter to left atrium and antegrade and retrograde cardioplegia cannulae are placed. Aorta is clamped and cardioplegia is administered. The technique of circulatory arrest is the same as described for surgery for aortic arch aneurysms. It is necessary to have circulatory arrest so as to have a bloodless field at the time of thrombo endartereclomy and to reduce blood loss.
Retrograde cerebroplegia is used at the time of circulatory a-rest for better cerebral protection.
First the right pulmonary artery is opened up to the hilum and correct plain for endarterectomy is developed and specimen removed from lobar and segmental branches. The pulmonaly arterial incision is closed. The period of circulatory best is limited to 20 lo 25 minutes. If more time is needed, a period of circulation for 7 to 10 minutes is re-established and then pump is stopped again. An incision is made on main pulmonary artery and it is extended Lo the left hilum. Specimen is removed from left pulmonary artery and its branches. After closing pulmonary arteriotomy, patient is rewarmed. Right atrium is opened and if a patent foramen ovale is present it is closed. Inferior vena caval filler is placed if it is not already there. Patients are electively ventilated and anti-coagulants started when surgical bleeding has stopped.