RESUMO
Placing retractor and stabilization devices during open heart surgery can be difficult in obese patients due to extremely short neck and excessive breast tissue. Off-pump coronary bypass operations in these patients can be particularly technically demanding. To overcome this difficulty, we have used two retractors concomitantly. The first retractor is placed to the edges of sternum and the second one is placed into this first retractor. This maneuver ensures an extra height, and placing stabilization devices in this second retractor is relatively easy. Thus, we suggest that adding this maneuver will facilitate off-pump coronary bypass operations.
RESUMO
Seven patients underwent pericardial patch closure of the left atrial appendage orifice in our clinic. Usually 5-to-7 U-sutures with 4-0 prolene were placed to the left atrial appendage orifice. These sutures were stretched out to measure exact sizes of the left atrial appendage orifice. Then, U-sutures were passed through the pericardial patch which was treated with glutaraldehyde. Pericardium was placed over the left atrial appendage orifice through the left atrium and stay sutures were tied. The upper suture was continuously sutured along the border of the orifice clockwise and tied to the lower suture. The lower suture was continuously sutured in a counter-clockwise direction and tied to the upper suture. Then, mitral valve surgery (repair or replacement) was performed.
