Secure closure of right ventricular perforation reinforced with coronary artery wall

We describe a method which is safe and reproducible.It is not uncommon for the right ventricular perforation to occur during dissection for exposure of intra myocardial left anterior descending artery (LAD) as a part of coronary artery bypass grafting and in unroofing procedure for myocardial bridging.This complication is likely to develop when the dissection is kept to the right side of anterior descending artery. The right ventricular cavity comes closest to the LAD in the intramyocardial portion separated only by thin layer of muscle and endothelium. Several techniques are in vogue for dealing with this potentially serious complication. Two common groups of techniques are described. These involve indirect and direct methods. In the indirect method teflon strip or pledgets are used on either side of anterior descending artery and under running the cavity by suture. Since in this technique the cavity is indirectly closed with under running the LAD there is risk of distal ischaemia. Direct method closes the perforation directly by pledgetted suture or patch of pericardium thereby reducing the chances of distal ischaemia. However since the wall of perforation is thin there is persistent danger of recurrent bleeding and pledget sutures causing fibrosis and late distal ischaemia.We describe a technique which is effective against the rebleeding and preventing the distal ischaemia associated with traditionally used methods.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research