Newly Developed Holder for a Right-Angled Metal Venous Cannula Takashi Watanabe, MD, Toshio Abe, MD, Minoru Tanaka, MD, Kenzo Yasuura, MD, Hiroshi Hikosaka, MD, Yoshito Suenaga, MD, and Hidekazu Hosokawa, MD Department of Thoracic Surgery, Nagoya University School of Medicine, and Division of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
A newly developed holder for a right-angled metal venous cannula was developed to make direct insertion into each cava easier, especially insertion into the superior vena cava in pediatric open heart operations. We have been using this holder with ease and safety in all cases of small babies. (Ann Thorac Surg 1992;54:9934.)
I
n pediatric open heart operations, a right-angled metal cannula for direct vena caval cannulation (Pacifico’s venous cannula; DLP Inc, Grand Rapids, MI) is frequently used to maintain good venous drainage and good exposure of the right atrium [l].Although insertion into the inferior vena cava is relatively easy, it is often difficult to insert the cannula into the superior vena cava* that Of Small babies or infants. Beginners in cardiovascular surgery who are not accustomed to this cannula may often have difficulty in doing it, which can be a cause of
A
B
Fig 1. The right-angled metal venous cannula is attached to a newly deve[oped holder, The holder is made of polyvinyl chloride and can make a straight line from the metal tip to the flexible plastic tube after arch formation.
C
Fig 2. lnsertion of the right-angled metal cannula into the superior vena cava (SVC) with the holder. The operator can make the insertion in the usual manner for cannulation. (RA = right atrium.) Accepted for publication July 15, 1992. Address reprint requests to Dr Watanabe, Department of Thoracic Surgery, Nagoya University School of Medicine, 65 Tsurumai-Cho, ShowaKu, Nagoya 466, Japan.
0 1992 by The Society of Thoracic Surgeons
0003-4975/92/$5.00
994
Ann Thorac Surg
HOW TO DO IT WATANABE ET AL NEW CANNULA HOLDER
bleeding around the insertion site. We developed a holder to resolve this problem. The right-angled metal venous cannula is attached to the polyvinyl chloride holder, which makes a straight line from the metal tip to the flexible plastic tube after arch formation (Fig 1). As for a usual venous cannulation, it is held in the right hand of an operator and its metal tip is inserted into the superior vena cava directly through a small incision (Fig 2). A pursestring suture around the
1992;54:993-4
incision with a tourniquet is tightened by an assistant, and the holder is released. We have been using this holder with ease and safety in all pediatric open heart operations for small babies.
Reference 1. Kirklin JW, Barratt-Boyes BG. Clinical methodology of cardiopulmonary bypass. In: Kirklin JW, Barratt-Boyes BG, eds. Cardiac surgery. New York: Wiley, 1985:59.
REVIEW OF RECENT BOOKS
A Textbook of Cardioplegia for Difficult Clinical Problems Edited by Richard M . Engelman, M D , and Sidney Levitsky, M D Mount Kisco, NY,Futura, 1992 334 pp, illustrated, $75.00
Reviewed by Edward Y . Sako, M D , PhD An international group of contributors have been assembled in a book that addresses not only cardioplegia but the general field of myocardial protection in a variety of clinical situations. The two editors are both well-known cardiac surgeons with a great deal of experience in this field. As noted in the preface, many of the topics were presented at the International Conference on Cardioplegia held in Oxford, England, in August 1990. The book begins with chapters outlining the historical development of myocardial protection both in the United States and in Europe. Although brief, they give some perspective to the book and highlight many of the pioneers in the field. The book then moves on to specific clinical problems. Topics covered include aortic regurgitation, percutaneous transluminal coronary angioplasty (PTCA) failure, reoperations for coronary artery disease, methodologies employed for the dysfunctional or impaired ventricle, various valve operations, acute myocardial infarction, cardiac arrhythmia surgery, trans-
plantation, and pediatric heart surgery. Many of the topics are presented in a duplicate fashion. For example, there are two chapters entitled “Cardioplegia for PTCA failure” and two chapters entitled “Cardioplegia for the dysfunctional ventricle.” This allows the reader to compare different approaches to a given problem. The individual chapters themselves are fairly succinct, averaging 10 to 15 pages each. Although some contain discussions of theoretical considerations and experimental studies, the majority of time is spent on practical clinical application. The techniques discussed include use of retrograde cardioplegia, blood versus crystalloid cardioplegia, substance-enhanced solutions, and warm continuous administration. Among the various chapters there is often overlap, repetition, and in some cases contradiction. This is to be expected given the variety of authors and the controversial nature of this field. The value of the book lies in the presentation of the specific protocol used by each author in the given clinical situations. This book is an excellent reference and update on the latest methods of myocardial preservation. It should prove to be of value to any practicing cardiac surgeon.
San Antonio, Texas
A newly developed holder for a right-angled metal venous cannula was developed to make direct insertion into each cava easier, especially insertion into the superior vena cava in pediatric open heart operations. We have been using this holder with ease and safety in all cases of small babies. (Ann Thorac Surg 1992;54:9934.)
I
n pediatric open heart operations, a right-angled metal cannula for direct vena caval cannulation (Pacifico’s venous cannula; DLP Inc, Grand Rapids, MI) is frequently used to maintain good venous drainage and good exposure of the right atrium [l].Although insertion into the inferior vena cava is relatively easy, it is often difficult to insert the cannula into the superior vena cava* that Of Small babies or infants. Beginners in cardiovascular surgery who are not accustomed to this cannula may often have difficulty in doing it, which can be a cause of
A
B
Fig 1. The right-angled metal venous cannula is attached to a newly deve[oped holder, The holder is made of polyvinyl chloride and can make a straight line from the metal tip to the flexible plastic tube after arch formation.
C
Fig 2. lnsertion of the right-angled metal cannula into the superior vena cava (SVC) with the holder. The operator can make the insertion in the usual manner for cannulation. (RA = right atrium.) Accepted for publication July 15, 1992. Address reprint requests to Dr Watanabe, Department of Thoracic Surgery, Nagoya University School of Medicine, 65 Tsurumai-Cho, ShowaKu, Nagoya 466, Japan.
0 1992 by The Society of Thoracic Surgeons
0003-4975/92/$5.00
994
Ann Thorac Surg
HOW TO DO IT WATANABE ET AL NEW CANNULA HOLDER
bleeding around the insertion site. We developed a holder to resolve this problem. The right-angled metal venous cannula is attached to the polyvinyl chloride holder, which makes a straight line from the metal tip to the flexible plastic tube after arch formation (Fig 1). As for a usual venous cannulation, it is held in the right hand of an operator and its metal tip is inserted into the superior vena cava directly through a small incision (Fig 2). A pursestring suture around the
1992;54:993-4
incision with a tourniquet is tightened by an assistant, and the holder is released. We have been using this holder with ease and safety in all pediatric open heart operations for small babies.
Reference 1. Kirklin JW, Barratt-Boyes BG. Clinical methodology of cardiopulmonary bypass. In: Kirklin JW, Barratt-Boyes BG, eds. Cardiac surgery. New York: Wiley, 1985:59.
REVIEW OF RECENT BOOKS
A Textbook of Cardioplegia for Difficult Clinical Problems Edited by Richard M . Engelman, M D , and Sidney Levitsky, M D Mount Kisco, NY,Futura, 1992 334 pp, illustrated, $75.00
Reviewed by Edward Y . Sako, M D , PhD An international group of contributors have been assembled in a book that addresses not only cardioplegia but the general field of myocardial protection in a variety of clinical situations. The two editors are both well-known cardiac surgeons with a great deal of experience in this field. As noted in the preface, many of the topics were presented at the International Conference on Cardioplegia held in Oxford, England, in August 1990. The book begins with chapters outlining the historical development of myocardial protection both in the United States and in Europe. Although brief, they give some perspective to the book and highlight many of the pioneers in the field. The book then moves on to specific clinical problems. Topics covered include aortic regurgitation, percutaneous transluminal coronary angioplasty (PTCA) failure, reoperations for coronary artery disease, methodologies employed for the dysfunctional or impaired ventricle, various valve operations, acute myocardial infarction, cardiac arrhythmia surgery, trans-
plantation, and pediatric heart surgery. Many of the topics are presented in a duplicate fashion. For example, there are two chapters entitled “Cardioplegia for PTCA failure” and two chapters entitled “Cardioplegia for the dysfunctional ventricle.” This allows the reader to compare different approaches to a given problem. The individual chapters themselves are fairly succinct, averaging 10 to 15 pages each. Although some contain discussions of theoretical considerations and experimental studies, the majority of time is spent on practical clinical application. The techniques discussed include use of retrograde cardioplegia, blood versus crystalloid cardioplegia, substance-enhanced solutions, and warm continuous administration. Among the various chapters there is often overlap, repetition, and in some cases contradiction. This is to be expected given the variety of authors and the controversial nature of this field. The value of the book lies in the presentation of the specific protocol used by each author in the given clinical situations. This book is an excellent reference and update on the latest methods of myocardial preservation. It should prove to be of value to any practicing cardiac surgeon.
San Antonio, Texas
