Heart Transplantation in the Rat
Waldemar L. Olszewski in CRC Handbook of Microsurgery, 2019
The donor is anesthetized with ether. The thorax is shaved and the animal is taped on its back onto a cork board. About 500 U of heparin dissolved in 1 mℓ of saline is injected into the tail vein to prevent clotting in the donor heart. The anterior thoracic wall is cut free from the diaphragm and further opened via the two mid-axillary lines. The pericardium is incised and the heart is retracted distally. To obtain access to the ascending aorta and the pulmonary artery, these vessels are freed from one another by careful dissection. The ascending aorta is cut with iridectomy scissors close to the origin of the first branch and the pulmonary artery at its bifurcation. The heart is lifted up and one ligature (linen 100) is placed around the vena cavae and pulmonary veins. After cutting these veins distal to the ligature, the heart is removed. A fine polyethylene catheter connected with a 2-mℓ syringe containing Hanks’ balanced salt solution (HBSS) at 4°C is introduced into the ascending aorta. Under low pressure, the coronary system is gently perfused until the effluent escaping from the pulmonary artery is clear. The heart is stored in HBSS at 4°C.
Trunk
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
The spinal nerves divide into ventral rami and dorsal rami. The ventral rami form the intercostal nerves (T1–T12) in the thoracic region, as well as the cervical plexus, brachial plexus, lumbar plexus, and sacral plexus, thereby supplying the muscles and skin of the upper and lower limbs and part of the trunk. The lumbar plexus, sacral plexus, and pudendal plexus form the lumbosacral plexus. Intercostal nerves T1 to T11 lie together with the intercostal veins and intercostal arteries in the 11 intercostal spaces, while T12 is a subcostal nerve that courses below the 12th rib. The anterior end of an intercostal space is supplied by the anterior intercostal branches of the internal thoracic artery. The intercostal nerves supply the serratus posterior superior and serratus posterior inferior and the external intercostal muscle, internal intercostal muscle, and innermost intercostal muscle. The intercostal nerves also have cutaneous branches at the anterior (ventral) and lateral surfaces of the thoracic wall. The dorsal rami supply the paravertebral muscles (paraspinal muscles) and skin near the midline of the back.
The respiratory system
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
The pleural space is filled with pleural fluid, which lubricates the membranes and reduces friction between the layers as they slide past each other during breathing. The pleural fluid also plays a role in maintaining lung inflation. The cohesion between the molecules of the watery pleural fluid keeps the two layers of the pleura “adhered” to each other. This concept is similar to the effect of water between two glass microscope slides. The two pieces of glass can easily slide over each other; however, the strong attraction of the water molecules for each other opposes the direct separation of the slides. In this way, the lungs are in contact with the thoracic wall, fill the thoracic cavity and remain inflated. In other words, the cohesion of the fluid molecules in the pleural space opposes the tendency of the lungs to collapse.
Deployment of acute mechanical circulatory support devices via the axillary artery
Published in Expert Review of Cardiovascular Therapy, 2019
Raj Tayal, Colin S. Hirst, Aakash Garg, Navin K. Kapur
Best practices for percutaneous axillary access are lacking. An understanding of the anatomy of the anterior superior thoracic wall and shoulder is crucial for successful and safe vascular access and hemostasis. Vascular access can be organized into three distinct phases: obtaining access, maintaining access and obtaining hemostatic closure. We underscore the importance of ultrasound-guided vascular access and espouse the tools, like micropuncture needles and sheaths, to ensure accurate percutaneous arterial entry. While these tools are a part of the evolving literature regarding best practice patterns for arterial access of all endovascular procedures, we present a unique and user-friendly radiographic approach to successful axillary arterial access using the head of the humerus and the inferior aspect of the glenoid cavity. We hope this approach may encourage the interventional cardiologist, vascular surgeon or cardiothoracic surgeon to pursue this percutaneous skillset as a means to offer alternative access for those patients without patent conduits of the iliofemoral tree. Our foresight lends our group to believe that this skillset, in fact, will help to develop the next phase of subacute mechanical circulatory support devices: dischargeable endovascular pumps deployed via the axillary artery. Although this device subtype remains purely speculative, the development in this space may turn theory into reality.
Bilateral open pneumothorax resulting in a sucking chest wound
Published in Acta Chirurgica Belgica, 2018
Sami Karapolat, Alaaddin Buran, Atila Turkyilmaz
The patient was operated on while in the prone position under general anesthesia. A thoracotomy was performed on the right side and then on the left to access the defect areas on the thoracic wall. The lacerated areas on the posterior basal segments of the lower lobes of both lungs were primarily sutured before the thoracotomies were closed. The vertebral defect area was then explored and bone fragments were removed. It was seen that, the dura mater was absent in the cut area, leaving the lacerated spinal cord uncovered. Finally, the muscle, fascia, and the subcutaneous and skin tissues of the posterior thoracic wall were primarily sutured. The patient was discharged on day seven with paraplegia due to the injury. At a six-month follow-up, he was still receiving physiotherapy for the paraplegia.
Heterotopic Implantation of Decellularized Pulmonary Artery Homografts In A Rodent Model: Technique Description and Preliminary Report
Published in Journal of Investigative Surgery, 2018
Arben Dedja, Massimo A. Padalino, Mila Della Barbera, Cosimo Rasola, Paola Pesce, Anna Milan, Michela Pozzobon, David Sacerdoti, Gaetano Thiene, Giovanni Stellin
The donor rat was laid on a cork tray with the caudal part towards the surgeon and a xiphopubic incision with lateral openings was performed. The two superior musculocutaneous flaps were retracted laterally over the thorax. A volume of 1 mL of saline solution at 4°C containing 500 IU of heparin was administered through the abdominal vena cava (AVC). After 1 minute, the diaphragm was cut from left to right and the heart freed from the anterior thoracic wall. A wide bilateral thoracotomy was performed, cutting the posterior ribs near the spine with large scissors. The beating heart was cooled by dripping saline solution at 4°C over the organ. From then on, donor surgery was performed under × 10 and × 16 magnifications. To obtain a full view of the aortic arch, pericardium and thymus were removed. The aorta was then freed from the surrounding fatty tissue and cut at the arch, just above the origin of the anonymous artery, which was also cut. Immediately, an opening to the thoracic inferior vena cava was performed. The insertion of a 22G cannula into the opening was then completed and the heart was flushed with 20–25 mL of saline solution at 4°C, using little pressure. Perfusion was discontinued when the heart stopped beating and the flow coming from the aorta became clear. The pulmonary artery (PA) was divided close to the bifurcation trying to ensure maximum length, entering with one blade of the micro scissors underneath the vas. The PA was then gently held with the ring tip micro forceps and was divided from the right ventricle with the micro spring scissors, removing some muscle as well.