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Asian Cardiovasc Thorac Ann 1998;6:143-144
© 1998 Asia Publishing EXchange Pte Ltd

HOW TO DO IT

Cannulation of Left Inferior Pulmonary Vein and Distal Thoracic Aorta for Left Heart Bypass

Zubin Nalladaru, MCh, Chen Qiang, MD, Ashok Kumar Sharma, FRACS

Department of Cardiothoracic Surgery Wellington Hospital Wellington South, New Zealand
For reprint information contact: Ashok Kumar Sharma, FRACS Department of Cardiothoracic Surgery Wellington Hospital Private Bag 7902 Wellington South, New Zealand Tel: 64 4 385 5999 Ext. 5222 Fax: 64 4 385 5538

   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 TECHNIQUE
 DISCUSSION
 REFERENCES
 
We describe a simple safe technique of left heart bypass using cannulation of the posterior aspect of the left inferior pulmonary vein for repair of an aneurysm in the distal aortic arch.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
TECHNIQUE
 DISCUSSION
 REFERENCES
 
Left heart bypass is typically established by cannulation of the left atrium via the left atrial appendage and the distal thoracic aorta or the femoral artery.1 The disadvantages of left atrial appendage cannulation are: (1) that the left atrial appendage may be narrow and friable and thus easily torn during cannulation resulting in bleeding, and (2) if the cannula is not placed in the body of the left atrium, flow may be limited by sumping of the appendage. Fullerton2 used the left superior pulmonary vein as an alternative site for cannulation of the left atrium in 4 patients and found that this method was easier than cannulating the left atrial appendage. More recently, Lick and colleagues3 described cannulation of the left inferior pulmonary vein in 20 patients which was technically easier than cannulating the left superior pulmonary vein. We describe a technique employing cannulation of the left inferior pulmonary vein on its posterior aspect, which does not require opening the pericardium to establish left heart bypass. This method was used to repair a distal aortic arch aneurysm.


   TECHNIQUE
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
DISCUSSION
 REFERENCES
 
The technique was performed on a 62-year-old male who presented with an aneurysm of the distal aortic arch. Using one-lung anesthesia, the chest was opened via a left posterolateral thoracotomy through the 4th intercostal space. The aneurysm was found to extend from a point distal to the origin of the left common carotid artery up to 3 cm distal to the left subclavian artery, the origin of which was displaced posterolaterally by the aneurysm. The aorta proximal and distal to the aneurysm and the left subclavian artery were dissected and looped. The inferior pulmonary ligament was divided and the inferior pulmonary vein was dissected extrapericardially. An oval-shaped pursestring suture of 4/0 polypropylene was placed along the longitudinal axis of the vein to avoid narrowing its lumen when tied. A straight-tipped wire-reinforced 30 F cannula (CR Bard, Inc., Santa Ana, CA, USA) was inserted through an opening in the pursestring suture (Figure 1Go). The distal thoracic aorta was then cannulated. Since we did not have a centrifugal pump at our institute we had to heparinize the patient and use a conventional roller pump. Bypass was commenced at a flow rate of 3 L•min–1. Femoral pressure during left heart bypass was maintained at a mean of 70 mm Hg. The clamps were applied and the aneurysm was resected and repaired using a 26-mm Hemashield graft (Meadox Medicals, Inc., Oakland, NY, USA). The clamps were then released, hemostasis was achieved, and the patient was weaned off bypass. The left subclavian artery was reimplanted into the graft using a partial clamp.



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  		Figure 1. Operative photograph showing the cannulated inferior pulmonary vein and the descending thoracic aorta.

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
 DISCUSSION
REFERENCES
 
Left heart bypass is routinely used for surgical procedures on the distal aortic arch and descending thoracic aorta, which necessitate clamping for a variable period of time. It has been proven that this technique virtually eliminates the risk of paraplegia, avoids physiologic overload of the left ventricle, and prevents splanchnic and lower torso ischemia.2,4

We found after cannulation of the inferior pulmonary vein that blood inflow was excellent and a flow of 3 L•min–1 could be maintained. Lick and colleagues3 cannulated the inferior pulmonary vein for the treatment of traumatic thoracic aortic tears, aneurysms of the descending thoracic aorta, and coarctation of the aorta. However, their technique of cannulating the left inferior pulmonary vein at its anterior aspect necessitates opening the pericardium. In the technique described here, the posterior aspect of the inferior pulmonary vein was cannulated without opening the pericardium. We found that this procedure was simple to perform and consider that it may be safer than other conventional methods for establishing left heart bypass.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
 DISCUSSION
 REFERENCES
 

  1. Hess PJ, Howe HR, Robicsek F. Traumatic tears of the thoracic aorta: improved results using the Biomedicus pump. Ann Thorac Surg 1989;48:6–9.[Abstract]

  2. Fullerton DA. Simplified technique for left heart bypass to repair aortic transection. Ann Thorac Surg 1993;56:579–80.[Abstract]

  3. Lick SD, Conti VR, Zwischenberger JB, Kurusz M. Simple technique of left heart bypass. Ann Thorac Surg 1996; 61:1555–6.[Abstract/Free Full Text]

  4. McCroskey BL, Moore EE, Moore FA, Abernathy CM. A unified approach to the torn thoracic aorta. Am J Surg 1991;162:473–6.[Medline]





This Article
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Right arrow Full Text (PDF)
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Services
Right arrow Email this article to a friend
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Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Zubin Nalladaru
Qiang Chen
Ashok Kumar Sharma
Right arrow Permission Requests
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Right arrow Citing Articles via Google Scholar
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Right arrow Articles by Nalladaru, Z.
Right arrow Articles by Sharma, A. K.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Nalladaru, Z.
Right arrow Articles by Sharma, A. K.

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