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Extra info for Umbar: Haven of the Corsairs (MERP Middle Earth Role Playing)
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Atrial Cannulation in Reoperation In reoperation, the atrial wall is sometimes thin and friable, and its dissection can be tedious and hazardous. It is advantageous to leave a segment of pericardium intact on the atrial wall through which cannulation can be performed safely and securely (Fig. 2-21). FIG 2-17. Surgical anatomy of the sinoatrial node and surrounding structures. FIG 2-18. Clamp injury to the sinoatrial node. FIG 2-19. Clamp injury to the right coronary artery. FIG 2-20. Management of a right coronary artery clamp injury.
Left Ventricular Wall Bleeding Purse-string sutures are not required to hold the cannula in place, and may cause troublesome bleeding. Injury to Left Anterior Descending Artery The cannulation site should be well away from the left anterior descending coronary artery on the anterior wall of the left ventricle. Venous Cannulation Right Atrial Cannulation Technique A single, large, dual-stage atriocaval cannula provides satisfactory venous return for most cardiac surgical procedures. This cannula is introduced through a purse-string suture in the right atrial appendage so that the tip lies in the inferior vena cava and the basket lies in the right atrium (Fig.
5 times the diameter of the sinotubular junction. In general, the noncoronary cusp is slightly larger than the other two, and the left is the smallest. FIG 5-1. A: Posteroanterior view of the heart with the aorta and pulmonary artery transected above the sinuses. The atria have been removed at the level of the atrioventricular valves. The noncoronary sinus has been excised at the noncoronary annulus and the aortic leaflets have been removed. B: Superior view into the aortic root. The leaflets have been excised.