SU891076A1 - Method of shunting coronary arteriae - Google Patents

Description

(54) METHOD OF THE CORRUPTION ARTERY SHUNTING

one

This invention relates to medicine, namely to surgery of the coronary arteries.

There is a method of bypassing the coronary arteries by connecting the internal thoracic artery with the branch of the left coronary artery 1.

However, the known method is complex and traumatic, since the internal thoracic artery supplies only one coronary artery after the operation, and the second internal thoracic artery is required for the second blood supply.

The purpose of the invention is to reduce the morbidity and simplify the operation.

This goal is achieved in that, according to the method of bypassing the coronary arteries, by connecting the internal thoracic artery with a branch of the left coronary artery, the internal thoracic artery is connected to the second branch of the left coronary artery, and one branch of the left coronary artery is connected to the distal end of the internal thoracic artery arteries of the type "end to end or" end of the ca., and the other branch of the left coronary artery is connected with the proximal end of the internal thoracic artery of the type "side to side.

The method is carried out as follows.

Surgical access is common for interventions on coronary arteries - mid sternotomy or left-sided thoractomy. Left inner thoracic

5, an artery is isolated from the mouth to the level of the third or fourth intercostal space. The peripheral end of the artery is ligated, and a soft clamp is applied to the central one, the artery is crossed at the distal end.

The pericardium is then opened and two large branches of the left coronary artery are separated in the segments where the anastomosis is to be applied. After that, proceed to the imposition of a proximal anastomosis between the internal thoracic artery and the closer selected branch of the left coronary artery of the type “side to side. At the end of the first anastomosis, the distal end of the internal thoracic artery is connected to the second branch of the left coronary artery in an "end to end, or" end

Claims (1)

20 in the side. Both anastomosis are performed by conventional methods of vascular surgery. As a result of the operations, the blood supply to the two branches of the left coronary artery is made through one left internal thoracic artery. Example. The operation was carried out on 19 dogs weighing from 12 to 29 kg. After medication and induction anesthesia, left-sided lateral access along the intercostal space was applied. The left internal thoracic artery was mobilized, starting from the place of discharge from the connected artery to the level of the 1U – U intercostal space along with the surrounding tissues and accompanied by a vein. Selected internal thoracic arteries intersected at the level of 1U and At the intercostal space (if possible, below) and clamped with a special terminal. The pericardium was opened with a wide longitudinal incision, completely opening both branches of the left coronary artery. Further, depending on the length and. the inner thoracic artery, the diameter, and the specific features of the coronary artery branching were allocated to the middle OR, third of the anterior interventricular, diagonal, or circumflex branch of the Left coronary artery. After this, they proceeded to the implementation of the proximal anastomosis. between the internal thoracic artery and one of the branches of the left coronary artery of the “side to side by 30-45 mm above the peripheral end of the internal thoracic artery. The conventional technique used to manually crush small vessels was used or special tools and tools were used. At the end of the anastomosis, the blood flow in the coronary artery was restored and hemostasis was performed. After the recovery of all hemodynamic and electrocardiographic parameters, anastomosis was initiated between the peripheral end of the internal thoracic artery and the second branch of the coronary artery. The anastomosis was applied end-to-end using the mechanical seam of an ASTs-VAK-1 vacuum vessel-vessel. The permeability of both anastomoses was checked by injecting 1 ml of a 1 ° / about solution of methylene blue with a syringe and using an electromagnetic flowmeter. Of the 29 experiments in 11, it was possible to achieve complete permeability of both anastomoses. The data were confirmed by electrocardiographic and X-ray monitoring. The proposed method is applied on 8 human corpses. All the operations performed showed that the proposed method is simpler and less traumatic than the known one, since one internal thoracic artery is enough to bypass two coronary arteries. Claims for shunting the coronary arteries 5 by connecting the internal thoracic artery with a branch of the left coronary artery, characterized in that, in order to reduce the morbidity and simplify the operation, the internal thoracic artery is co-juxtaposed with the second branch of the left coronary artery, while one branch of the left coronary artery the coronary artery is connected to the distal end of the end to end or end to the side, and the other coronary artery is connected by the proximal end of the internal thoracic artery of the type side to side. Sources of information taken into account in the examination Kolesov V.I. Surgeons of the coronary arteries of the heart M., Medicine, 1977, p. 170-171, 253-258.