The operation: Surgical planning and the position
- Following median sternotomy, the thymus was subtotally excised taking
care not to expose the brachiocephalic vein. The pericardium was
incised about 5-6 mm in front of and parallel to the phrenic nerve,
thus exposing the two great arteries, the right atrium and the
superior vena cava. The pericardium was opened using scissors and not
cautery to avoid inadvertent cautery-induced ventricular fibrillation.
A rectangular segment of pericardium was harvested and fixed in 10%
glutaraldehyde for 10 minutes for later use of right ventricular
outflow tract reconstruction.
- The position and size of the great arteries, as well as the site of
origin and distribution of the coronary arteries was determined. All
four chambers were inspected and pressures recorded. Note the
anteroposterior disposition of the aorta and the main pulmonary artery
with the left main coronary artery arising from the left posterior
aortic sinus and the right coronary artery arising from the right
posterior aortic sinus. The left main coronary artery giving origin to
the left anterior interventricular coronary artery and circumflex
coronary artery.
- The operation was performed with moderately hypothermic
cardiopulmonary bypass at 32°C. Angled venous cannulas were inserted
into the superior and inferior caval veins and with distal aortic
cannulation. Measures were taken to avoid excessive manipulation.