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Trunk Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Rowan Sherwood
Jelev et al. (2011) note that understanding the variation in attachments of transversus thoracis is important due to the close anatomical relationship of this muscle to the internal thoracic artery, which is an important vessel for coronary artery bypass grafting (CABG) surgery.
Anatomy of the Anterior Abdominal Wall
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The thoracic aorta gives rise to nine pairs of segmental arteries – the (3rd–11th) intercostal arteries and the (12th) subcostal arteries. These vessels follow the same course as the spinal nerves described earlier. The 10th and 11th intercostal arteries pass deep to the costal margin to supply the lateral zone and anastomose with the subcostal, superior epigastric and lumbar arteries. The intercostal arteries above this level do not enter the abdominal wall but terminate by anastomosing with the musculophrenic arteries and may contribute to the blood supply of the abdominal wall through this route. Remember that in patients who have undergone coronary artery bypass grafting the left internal thoracic artery is likely to have been disconnected from the superior epigastric artery, and flow into the vessel will be through this intercostal anastomosis. This may not be sufficient to support a TRAM flap.
Cardiothoracic Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Selection of conduitsVenous graftsThe long saphenous vein is the most common vein used as a conduit. The 10 year patency rate is 50-60%.Arterial graftsThe left internal mammary artery/internal thoracic artery is the conduit of choice for left anterior descending artery. The 10 -year patency rate is 90%.Radial artery can also be used as a second choice but is prone to vasospasm.
Numerical study of hemodynamics in a complete coronary bypass with venous and arterial grafts and different degrees of stenosis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Shila Alizadehghobadi, Hasan Biglari, Hanieh Niroomand-Oscuii, Meisam H. Matin
One of the most prevalent cardiovascular diseases is coronary artery disease which is the leading cause of death all over the world (Wong 2014). The stenosis or blockage of the artery brings about a reduction of blood flow to the heart muscle and therefore causes problems for blood supply to the heart. One of the main treatments for the coronary artery blockage is bypass surgery in which an alternative graft is used to compensate for the blood flow reduction through the coronary artery (Arima et al. 2005; Deb et al. 2013). This graft is connected to the aorta from upstream and to the coronary artery from downstream. Internal thoracic artery (ITA) and small saphenous vein are the commonly used vessels in bypass. The main issue encountered after the bypass surgery is stenosis or partial blockage of the graft which occurs due to the variations in the hemodynamic conditions leading to the failure of the grafting. The hemodynamic conditions strongly depends on the mechanical properties of the artery tissues. Since the accurate experimental evaluation of the parameters is almost elusive due to the challenges associated with the ultrasonic velocity measurement, numerical simulations can examine the flow conditions and hemodynamics conveniently but with some limitations. Owida et al. (2012) provided an overview on numerical simulations of the flow pattern and wall shear stress in the occluded coronary arteries.
Left-handedness in cardiac surgery: who’s right?
Published in Acta Chirurgica Belgica, 2020
K. Cathenis, J. Fleerakkers, W. Willaert, P. Ballaux, D. Goossens, R. Hamerlijnck
After the sternotomy and initial hemostasis have been performed, the Internal Thoracic Artery (ITA) is harvested. In our center, the pleural space remains closed and the ITA is brought down with cautery. The ITA is prelevated without fascia. The cable of the cautery is placed behind the sternal retractor to prevent the cable getting in the line of sight (Figure 2). The placement of hemostatic clips is performed with both hands, and they are given forehand to both hands. There should be no difference in technique regarding prelevation of the left or right ITA for the LHD surgeon. There does not seem to be an advantage or difference prelevating the right ITA for the left handed surgeon as opposed to the right handed surgeon. The scrub nurse can find it difficult to hand over the instruments because of the small distance to the left hand of the surgeon. If the scrub nurse experiences problems, let them stand on the other side of the table.
Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery
Published in Disability and Rehabilitation, 2019
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
Anaesthetic procedures were conducted in a routine fashion with midazolam, maintained with sufentanil and isoflurane (0.5–1%). Off-pump coronary artery bypass grafting was accomplished through a median sternotomy, using the left internal thoracic artery complemented with additional saphenous vein grafts. The left internal thoracic artery was harvested by the skeletonised technique, with meticulous caution routinely taken to preserve pleura integrity in order to preserve respiratory system compliance and resistance. Off-pump coronary artery bypass grafting follows our standardised protocol [3]. In all cases, an Octopus 3 (Medtronic, Inc., Minneapolis, MN) suction stabiliser was utilised, and to maintain normothermia, a heated water mattress was used throughout the operation.