E. Dregelid, MDa, K. Heldal, MDb, F. Resch, MDa, L

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Presentation transcript:

Dilation of the internal mammary artery by external and intraluminal papaverine application E. Dregelid, MDa, K. Heldal, MDb, F. Resch, MDa, L. Stangeland, MD, PhDa, K. Breivik, MD, PhDa, E. Svendsen, MD, PhDb The Journal of Thoracic and Cardiovascular Surgery Volume 110, Issue 3, Pages 697-703 (September 1995) DOI: 10.1016/S0022-5223(95)70101-X Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 Diagram shows distal, resected part of IMA pedicle. First clip was applied to prevent bleeding; second and third to fix steel rod to IMA to "splint" it and prevent its retraction. Second and third clip were applied while pedicle was stretched to its original length. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 697-703DOI: (10.1016/S0022-5223(95)70101-X) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 Diagram of measured and calculated variables. Perimeter of media (PM), area of media (M),area of intimal layer (IL) (equal to area between luminal circumference (LC) and folded internal elastic lamina [IEL]), length of folded internal elastic lamina, and luminal area (LA) were measured. Following variables were calculated: Re, external radius = PM/2π; Ri, internal radius = √(πRe 2 –M)/π; and CC, length of circle circumscribing same area as internal elastic lamina = 2πRi. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 697-703DOI: (10.1016/S0022-5223(95)70101-X) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 Photomicrographs of cross sections of distal IMA segments that could not be evaluated morphometrically because of vessel wall injury (original magnification × 30). All these segments belonged to groups 2 or 3 (intraluminal papaverine). A, Advanced dissection between tunica media and external elastic lamina is shown. Some blood remains in dissected space (star). B, Rupture (arrow) of tunica media has taken place. Minor dissection between tunica media and external elastic lamina also appears (star). C, Shown are Minor dissection(star) and side branch (arrow) dislodged into IMA lumen indicating that dissection at more distal level has taken place. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 697-703DOI: (10.1016/S0022-5223(95)70101-X) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 Photomicrographs of cross sections of distal IMA segments that could not be evaluated morphometrically because of vessel wall injury (original magnification × 30). All these segments belonged to groups 2 or 3 (intraluminal papaverine). A, Advanced dissection between tunica media and external elastic lamina is shown. Some blood remains in dissected space (star). B, Rupture (arrow) of tunica media has taken place. Minor dissection between tunica media and external elastic lamina also appears (star). C, Shown are Minor dissection(star) and side branch (arrow) dislodged into IMA lumen indicating that dissection at more distal level has taken place. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 697-703DOI: (10.1016/S0022-5223(95)70101-X) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 Photomicrographs of cross sections of distal IMA segments that could not be evaluated morphometrically because of vessel wall injury (original magnification × 30). All these segments belonged to groups 2 or 3 (intraluminal papaverine). A, Advanced dissection between tunica media and external elastic lamina is shown. Some blood remains in dissected space (star). B, Rupture (arrow) of tunica media has taken place. Minor dissection between tunica media and external elastic lamina also appears (star). C, Shown are Minor dissection(star) and side branch (arrow) dislodged into IMA lumen indicating that dissection at more distal level has taken place. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 697-703DOI: (10.1016/S0022-5223(95)70101-X) Copyright © 1995 Mosby, Inc. Terms and Conditions