冠心病的诊断与治疗.ppt

* The saphenous was isolated, ligated and divided at the ankle.  * The harvested saphenous vein is shown. The length harvested was designed to allow three vein bypass grafts.  * The patient was placed on cardiopulmonary bypass (see aortic valve replacement).  * The coronary artery branches were inspected. The left anterior descending is shown (patients head to right).  * The heart is elevated to show the posterior descending branch of the right coronary.  * A Beaver blade was used to incise the epicardium over the posterior descending (patients head to right)..  * The heart was cooled with slush and the heart was stopped with antegrade followed by retrograde cardioplegia solution.  * The spatulated end of the saphenous vein was anastomosed in a heel-toe fashion end to side to the posterior descending using 7-0 polypropylene monofilament suture.  * The completed posterior descending anastomosis is shown.  * The second anastomosis was made to the obtuse marginal off the left circumflex.  * The completed internal mammary anastomosis is shown.  * The cardioplegia was reversed, the bypass reduced to partial and the heart was restarted with paddles.  * The cutting end of the punch is shown.  * The proximal anastomoses were created with 5-0 monofilarment polypropylene. The side biting clamp was removed and the patient weaned from bypass.  * A second chest tube was placed as a mediastinal drain.  * The field was carefully checked for hemostasis and the sternum was approximated with #7 stainless steel wires. The top three were placed through the body of the manubrium and the lower wires throught the intercostal spaces.  * The sternal incision was closed in layers. 体外循环冠状动脉旁路移植术(CPB－CABG） 取大隐静脉  取下的SV 体外循环冠状动脉旁路移植术(CPB－CABG） 体外循环冠状动脉旁路移植术(CPB－CABG） 建立体外循环 体外循环冠状动脉旁路移植术(CPB－CABG） 探查冠状动脉，显露前降支 体外循环冠状动脉旁路移植术(CPB－CABG） 搬起心脏，显露右冠的后降支 体外循环冠状动脉旁路移植术(CPB－CABG） 标记要搭桥的动脉 体外循环冠状动脉旁路移植术(CPB－CABG） 停跳心脏，心包腔放冰屑 体外循环冠状动脉旁路移植术(CPB－CABG） SV-PDA吻合 体外循环冠