福建医科大学外科学冠心病.pptVIP

* FIGURE 45-14 Brachiocephalic vessels can be reattached to an arch graft as a unit if the inner cylinder of origin of each vessel remains intact. (A) The arch vessels are excised as a unit from the superior surface of the dissected aortic arch. (B) The separated layers of the brachiocephalic patch are reunited using inner and outer felt strips and continuous suture. (C) A corresponding hole is cut into the aortic graft and the brachiocephalic unit is sutured into place. (Reproduced with permission from Stone C, Borst H: Dissecting aortic aneurysm, in Edmunds LJ Jr (ed): Cardiac Surgery in the Adult. New York, McGraw-Hill, 1997; p 1125.) * FIGURE 45-15 The brachiocephalic vessels are separated from the true lumen by the dissected false lumen (left panel). If individual brachiocephalic vessels also are damaged beyond repair, short, interposition grafts are added to reconnect each artery to the aortic graft (right panel). (Reproduced with permission from Stone C, Borst H: Dissecting aortic aneurysm, in Edmunds LJ Jr (ed): Cardiac Surgery in the Adult. New York, McGraw-Hill, 1997; p 1125.) * FIGURE 46-9 Illustration of simple aortic tube graft placement with separate replacement of the aortic valve. (A) The aorta is clamped proximal to the innominate artery (aortic perfusion cannula not shown) and the diseased aorta is resected down to just above the aortic valve commissures. (B) A Dacron graft is sewn to the distal aorta with a 3-0 or 4-0 polypropylene suture reinforced with a strip of Teflon felt. (C) If aortic valve replacement is indicated, the diseased valve is excised. (D) The valve is replaced with the valve of the surgeons choice. (E, F) The graft is sewn to the proximal aorta with 3-0 or 4-0 polypropylene reinforcing the aortic tissue with a strip of Teflon felt. (Reproduced with permission from Downing SW, Kouchokos NT: Ascending aortic aneurysm, in Edmunds LH Jr (ed): Cardiac Surgery in the Adult. New York, McGraw-Hill, 1997; p 1163.) * FIGURE 46-12 Cla