Temporary luminal arteriotomy seal: III

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Presentation transcript:

Temporary luminal arteriotomy seal: III Temporary luminal arteriotomy seal: III. Postmortem arteriosclerotic human coronary artery Robin H Heijmen, MD, Cornelius Borst, MD, PhD, Chantal M Mouës, MD, Yvonne J.M van der Helm, MD, Paul F Gründeman, MD, PhD, Gerard Pasterkamp, MD, PhD The Annals of Thoracic Surgery Volume 67, Issue 1, Pages 120-123 (January 1999) DOI: 10.1016/S0003-4975(98)01236-3

Fig 1 (A) After insertion, the temporary luminal arteriotomy seal completely covered the arteriotomy and provided a bloodless operative field without obstructing recipient artery flow (B) During suturing, the flimsy seal gave way when a needle was inserted between the seal and the arterial wall. The Annals of Thoracic Surgery 1999 67, 120-123DOI: (10.1016/S0003-4975(98)01236-3)

Fig 2 Coronary arteriography revealing stenotic lesions throughout the left coronary artery. The anastomotic sites were intentionally located either distal to (closed arrows) or in (open arrow) an arteriosclerotic lesion. The Annals of Thoracic Surgery 1999 67, 120-123DOI: (10.1016/S0003-4975(98)01236-3)

Fig 3 Pressurizing the arteriosclerotic human coronary artery to 60 mm Hg after insertion of the seal resulted usually in an elliptical arteriotomy of only 1 to 1.5 mm in width (A), but sometimes in a much wider opening (B). The latter resembles our earlier observations in the healthy porcine coronary artery [4], in which the longitudinal incision widened to an almost round arteriotomy (C). The Annals of Thoracic Surgery 1999 67, 120-123DOI: (10.1016/S0003-4975(98)01236-3)

Fig 4 Longitudinal cross-section of an end-to-side anastomosis at the diagonal branch of the left anterior descending coronary artery, distal to an arteriosclerotic lesion. The thickened intimal layer resulted in an irregular wall surface adjacent to the suture line. The temporary luminal arteriotomy seal (dotted line) provided an instant dry operative field without producing a leak during suturing of the anastomosis. (Elastin van Gieson stain.) (Original magnification ×10 before 48% reduction). The Annals of Thoracic Surgery 1999 67, 120-123DOI: (10.1016/S0003-4975(98)01236-3)