Internal thoracic artery coronary artery bypass grafting

1. Patients with severe angina pectoris and incapacity to work, who are ineffective after medical system treatment. 2. Coronary angiography, coronary artery stenosis more than 50% or branch stenosis more than 75% of the diameter, stenosis of the distal segment of the artery is smooth, and its diameter is 1.5mm or more. 3. After myocardial infarction, coronary angiography showed significant coronary stenosis. 4. Angina pectoris complicated with left ventricular aneurysm, or with ventricular septal defect or valvular lesion. Treating diseases: angina Indication 1. Patients with severe angina pectoris and incapacity to work, who are ineffective after medical system treatment. 2. Coronary angiography, coronary artery stenosis more than 50% or branch stenosis more than 75% of the diameter, stenosis of the distal segment of the artery is smooth, and its diameter is 1.5mm or more. 3. After myocardial infarction, coronary angiography showed significant coronary stenosis. 4. Angina pectoris complicated with left ventricular aneurysm, or with ventricular septal defect or valvular lesion. Contraindications 1. Left ventricular function is low, left ventricular ejection fraction is less than 0.2, left ventricular end-diastolic pressure is greater than 3kpa (20mmhg). 2. Chronic heart failure, severe myocardial lesions, irreversible changes. 3. Systemic diseases such as severe diabetes, high blood pressure, renal function or pulmonary insufficiency. 4. Generally, those who are 65 years old should be considered carefully. Preoperative preparation 1. See extracorporeal circulation for open heart surgery before surgery. 2. Coronary angiography clearly identifies the location, extent and extent of obstruction. 3. If you have high blood pressure, you need to be treated with drugs to lower your blood pressure to the normal range. 4. For diabetics, surgery should be considered before drug control. 5. Hyperlipidemia, given a low-fat diet and anti-hyperlipidemia drugs. 6. If digitalis, quinidine, beta blockers, diuretics, anticoagulants, etc. have been used, the drug should be discontinued 3 to 5 days before surgery. 7. For patients who are preparing for saphenous vein grafting, it is necessary to know whether there is any history of surgery, ulcers, varicose veins and skin diseases in the lower limbs. Surgical procedure The inner diameter of the internal thoracic artery is 2 to 3 mm, which is close to the inner diameter of the coronary artery. After separation, the distal end is anastomosed with the coronary artery to form a good bypass channel. And only need to make an anastomosis, and there is no danger of intimal hyperplasia. However, the scope of this operation is narrow, and it is generally used for the anastomosis of the left thoracic internal artery and the anterior descending artery. 1. Separate the median incision of the sternum of the internal thoracic artery. Do not cut the happy bag temporarily, and gradually open the sternum to avoid tearing the internal thoracic artery. The mediastinal pleura was cut with an electric knife 1 cm from the inner side of the left internal thoracic artery. From the level of the 3rd and 4th costal cartilage, the full length of the thoracic blood vessel was separated from the part of the chest wall fascia from the costal cartilage surface. A vascular pedicle. When separating, all the traffic branches with the blood vessels in the thoracic can be cut off with a coagulator. Large traffic branches can be cut by silver clips or cut or silked [Fig. 10-1~3]. 2. After establishing systemic heparinization of the extracorporeal circulation, the distal part of the thoracic vascular pedicle can be cut off at the 6th intercostal level, and the artery can be separated separately at the broken end by about 2 cm, and slowly diluted from the distal end of the artery. Heparin or papaverine, observe if there is a leak should be sewed [Figure 10-4]. Finally, the vascular pedicle is wrapped in a wet gauze pad for use. Establish extracorporeal circulation. 3. The internal thoracic artery and the anterior descending coronary artery are measured to measure the distance to the anterior descending artery. The length of the internal thoracic artery should be determined as short as possible, but it should not cause tension after the heart is re-jumped. The distal end of the anterior descending branch is cut open, and the length is not more than 3 to 4 mm. After the proximal end of the internal thoracic artery is placed in the vascular clamp, the incision is made longitudinally at the anastomosis. The incision should be slightly longer than the anterior descending incision because the distal end will be cut. The vascular anastomosis can be sutured continuously. The double-ended needle is used to suture the distal incision of the thoracic artery and the distal incision of the anterior descending branch without tying. Then, sew 1/2 continuously on one side, and then suture 1/2 on the other side. The end of the internal thoracic artery is cut off. The last 2 needles are not ligated, and then the distal end of the anterior descending artery is gently pressed with a finger. Gas, ligation of the last 2 sutures [Figure 11-1 ~ 5]. 4. Close the chest incision, the heart re-jump, stop the extracorporeal circulation, carefully stop the bleeding, place the drainage tube and suture the chest incision layer by layer.

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