Surgical anatomy of the heart. Surgical anatomy of the heart, great vessels and valves of the heart

Name: Surgical anatomy of the heart according to Wilcox
Anderson R.G., Spicer D.E.
The year of publishing: 2015
The size: 113.98 MB
Format: pdf
Language: Russian

The practical guide "Surgical anatomy of the heart according to Wilcox" ed., Anderson R.G., et al., considers the surgical anatomy of the chambers of the heart, valves, conduction system, coronary bed of the heart. Surgical approaches to the above localizations are described, as well as an analytical description of hearts with congenital malformations. The questions of surgical anatomy of heart malformations with abnormal and normal segmental connection are outlined. Anomalies in the location of the heart, as well as large vessels, are highlighted.

This book has been removed at the request of the copyright holder.

Name: Workshop on operative surgery. Part 2. Fundamentals of laparoscopic surgery

The year of publishing: 2017
The size: 8.63 MB
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Language: Russian
Description: The training manual "Workshop on Operative Surgery", edited by Protasov A.V., et al., consists of two parts. The second part deals with the issues of laparoscopic surgery. The characteristics are highlighted ... Download the book for free

Name: Workshop on operative surgery. Part 1. Fundamentals of operative surgery
Protasov A.V., Smirnova E.D., Kaitova Z.S., Titarov D.L.
The year of publishing: 2017
The size: 2.91 MB
Format: pdf
Language: Russian
Description: The training manual "Workshop on Operative Surgery", edited by Protasov A.V., et al., consists of two parts. The first part deals with the basics of operative surgery. The characteristics are outlined ... Download the book for free

Name: Modern surgical instruments
Dydykin S.S., Blinova E.V., Shcherbyuk A.N.
The year of publishing: 2015
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Description: The training manual "Modern Surgical Instruments" edited by S.S. Dydykin contains information about modern instruments used in surgical practice, as well as the organization of modern ... Download the book for free

Name: Basic surgical skills
Sherris D.A., Kern Yu.B.
The year of publishing: 2015
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Name: Intestinal sutures and anastomoses in surgical practice
Shalkov Yu.L.
The year of publishing: 2013
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Description: Practical guide "Intestinal sutures and anastomoses in surgical practice" ed., Yu.L. Shalkov, considers the issues of intestinal anastomoses and sutures failure. Overlay methods are presented ... Download the book for free

Name: Algorithms for operational accesses. 2nd edition
Vorobyov A.A., Tarba A.A., Mikhin I.V., Zholud A.N.
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Ostroverkhov G.E., Bomash Yu.M., Lubotsky D.N.
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Kvashuk V.V.
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Description: Tutorial"Atlas of clinical anatomy of the head and neck" ed., Kvashuk V.V., considers the topographic anatomical features heads and necks, clinical anatomy. Bone anatomy presented...

Surgical anatomy of the heart, the main vessels and valves of the heart. coronary arteries.

Surgical anatomy of the heart

Holotopia. The heart, covered by the pericardium, is located in the chest cavity and makes up the lower part of the anterior mediastinum. The spatial orientation of the heart and its departments is as follows. Towards midline of the body, approximately 2/3 of the heart is located on the left and 1/3 on the right. The heart in the chest occupies an oblique position. The longitudinal axis of the heart, connecting the middle of its base with the apex, has an oblique direction from top to bottom, right to left, back to front, and the apex is directed to the left, down and forward. The spatial relationships of the chambers of the heart among themselves are determined by three anatomical rules: first, the ventricles of the heart are located below and to the left of the atria; the second - the right sections (atrium and ventricle) lie to the right and anteriorly of the corresponding left sections; third - the aortic bulb with its valve occupies a central position in the heart and is in direct contact with each of the 4 departments, which, as it were, wrap around it.

Skeletotopia . The frontal silhouette of the heart is projected onto the anterior chest wall, corresponding to its anterior surface and large vessels. In adults, the right border of the heart runs vertically from the upper edge of the cartilage of the II rib at its attachment to the sternum down to the V rib. In the second intercostal space, it is 1-1.5 cm from the right edge of the sternum. From the level of the upper edge of the III rib, the right border has the form of a gentle arc, with a bulge facing to the right, in the third and fourth intercostal spaces it is 1-2 cm away from the right edge of the sternum. At the level of the V rib, the right border passes into the lower one, which goes obliquely down and to the left, crossing the sternum above the base of the xiphoid process, and then reaches the fifth intercostal space 1.5 cm medially from the midclavicular line, where the apex of the heart is projected. The left border is drawn from the lower edge of the 1st rib to the 2nd rib 2-2.5 cm to the left of the left edge of the sternum. At the level of the second intercostal space and III rib, it passes 2-2.5 cm, the third intercostal space - 2-3 cm outward from the left edge of the sternum, and then goes sharply to the left, forming an arc, convex outwards, the edge of which is in the fourth and fifth intercostal spaces determined 1.5-2 cm medially from the left midclavicular line.

The projection of the holes and valves of the heart on the anterior chest wall is presented in the following form. The right and left atrioventricular orifices and their valves are projected along a line drawn from the point of attachment of the cartilage of the 5th right rib to the sternum to the point of attachment of the cartilage of the 3rd left rib. The right opening and the tricuspid valve occupy the right half of the sternum on this line, and the left opening and the bicuspid valve occupy the left half of the sternum on the same line. The aortic valve is projected behind the left half of the sternum at the level of the third intercostal space, and the pulmonary trunk valve is projected at its left edge at the level of attachment of the cartilage of the III rib to the sternum.

Syntopy. The heart is surrounded on all sides by the pericardium and through it is adjacent to the walls of the chest cavity and organs. The anterior surface of the heart is partially adjacent to the sternum and cartilages of the left III-V ribs (right ear and right ventricle). Anterior to the right atrium and left ventricle are the costal mediastinal sinuses of the left and right pleura and the anterior edges of the lungs. In children, in front of the upper part of the heart and pericardium is the lower part thymus. The lower surface of the heart lies on the diaphragm (mainly on its tendon center), while under this part of the diaphragm there are the left lobe of the liver and the stomach. The mediastinal pleura and lungs are adjacent to the left and right sides of the heart. They also go a little on the back surface of the heart. But the main part of the posterior surface of the heart, mainly the left atrium, between the orifices of the pulmonary veins, is in contact with the esophagus, thoracic aorta, vagus nerves, in the upper section - with the main bronchus. Part of the posterior wall of the right atrium is in front of and below the right main bronchus.

Great vessels and valves of the heart

The cavities of the right and left atria communicate with the cavities of the corresponding ventricles through the right and left atrioventricular orifices, along the circumference of which the cusps of the atrioventricular valves are attached: the right - tricuspid and left - bicuspid, or mitral. The atrioventricular openings are limited by fibrous rings, which are an essential part of the connective tissue backbone of the heart.

1 - pulmonary trunk; 2 - aorta; 3 - leaflets of the tricuspid valve; 4 - sashes mitral valve; 5 - membranous part of the interventricular septum; 6 - right fibrous ring; 7 - left fibrous ring; 8 - central fibrous body and right fibrous triangle; 9 - left fibrous triangle; 10 - ligament of arterial cone

coronary arteries

The main source of blood supply to the heart is the right and left coronary arteries of the heart, extending from initial department aorta. In most people, the left coronary artery is larger than the right one and supplies the left atrium, the anterior, lateral and most of the posterior wall of the left ventricle, part of the anterior wall of the right ventricle, and the anterior 2/3 of the interventricular septum. The right coronary artery supplies the right atrium, most of the anterior and posterior wall of the right ventricle, a small part of the posterior wall of the left ventricle, and the posterior third of the interventricular septum. This is a uniform form of blood supply to the heart.

For a long period in the world literature, the description of the anatomy of the heart was either fragmentary or highly specialized, covering individual issues. At the same time, a cardiologist and a cardiac surgeon, as a rule, deal with the heart, the departments of which are normally developed. This applies to the surgery of acquired defects, coronary surgery. Even with congenital defects, there is, as a rule, a violation of one department with a normal structure of others. Therefore, knowledge of the normal anatomy of the heart is essential. In 1980?1983 this gap was largely filled by the fundamental works of R. Anderson, A. Becker (1980, 1983), published as chapters in the cardiac surgery manuals G. Danielson (1980), J. Stark, M. de Laval (1983) , as well as in the form of an atlas "Cardiac anatomy". These works quickly gained worldwide recognition among cardiologists and cardiac surgeons. Developing an abstract on the surgical anatomy of the heart, we proceeded mainly from the data of R. Anderson, A. Becker as the most up-to-date, accurate and necessary in everyday practice.

The heart is located in the mediastinum and occupies its entire anteroinferior part. The long axis of the heart (from the middle of the base to the apex) runs obliquely from top to bottom from right to left, from front to back. In front, the heart is covered by the edges of the right and left lungs, with the exception of a small area in the region of the anteroinferior edge, directly adjacent to the chest wall. The heart has a base and an apex. The base of the heart includes the atria and large great vessels that flow into and depart from it. The apex is located in the lower left part of the chest. The heart is fixed by the base to the main vessels. The top is free. Fixation of the heart, in addition, is ensured by the presence of a pericardial cavity, into which the heart is, as it were, pressed by its main mass, remaining hanging on the transitional folds of the pericardium located in the region of its base.

The relationship of the heart to the organs of the chest and to the pericardium is quite fully described in the manuals on topographic anatomy and special works of Russian authors, and we will not dwell on this in detail. We will only point out that the apex of the heart and both ventricles are located intrapericardially, i.e., they are entirely in the cavity of the pericardial shirt. Also intrapericardially located are the ascending aorta, pulmonary trunk, ears of the right and left atria. Vena cava, both atria are covered by the pericardium on three sides, that is, they have a mesopericardial position. One of these walls (posterior) is not covered by the pericardium. Pulmonary veins and both pulmonary arteries are located extrapericardially, i.e., the pericardium covers only one, anterior, wall of them. In the pericardial cavity, inversions are distinguished, i.e., places where the pericardium passes from the free wall to the epicardium, covering one or another part of the heart and sinuses, or cavities that the pericardium lines entirely. There are two such sinuses: transverse and oblique. The transverse sinus is located between the ascending aorta and the pulmonary trunk in front and the left atrium and pulmonary veins from below and behind. The transverse sinus has a right and left opening, so that you can freely pass an instrument or finger under the ascending aorta and pulmonary trunk. The oblique sinus is a blind sac located under the heart. It is clearly visible if the heart is lifted by the top and taken to the right and up. This sinus may be the site of accumulation of fluid and blood in the pericardial cavity and is usually drained during surgery.

When viewed from the front, the heart resembles a pyramid, with the apex pointing down. The upper part of the pyramid forms the base of the heart (basis cordis). There are sternocostal (anterior) surface of the heart - facies sternocostalis (anterior), diaphragmatic (lower) - facies diaphragmatica inferior) and pulmonary (lateral) - pulmonalis (lateralis). Between the anterior and lateral surfaces of the heart, a blunt edge (margo obtusus) is formed, directed to the left. Between the front and lower surfaces there is an acute angle, the so-called sharp edge (margo acutus), directed to the right. During an external examination of the heart, two unequal sections are clearly distinguished - the upper, or, more precisely, the upper right, and the lower, or lower. The boundary between them is the coronal sulcus (sulcus coronarius), running from left to right from top to bottom. In the upper section, the protruding part of the heart includes the auricle of the right atrium, which, with its free end, covers the mouths of the superior vena cava and the ascending aorta. Up and to the left, the groove goes under the protruding section of the heart - the arterial cone (conus arteriosus), passes to the back surface and continues in the form of the back of the coronal groove encircling the heart in an oblique horizontal plane. The continuation of the arterial cone is the pulmonary trunk (truncus pulmonalis), which takes a horizontal direction and dives under the lower surface of the ascending aorta at its transition to the arch. An important landmark of the anterior surface is the anterior interventricular sulcus (sulcus interventricularis anterior), located to the left of the arterial cone and running along the heart to its apex. Wrapping back and up here, it passes into the posterior (lower) interventricular sulcus - sulcus interventricularis posterior (inferior), which merges with the coronary (atrioventricular) sulcus at the top, also encircling the heart, but in the oblique plane. Thus, in the heart distinguish base, top, three surfaces, two edges and two circular furrows. It is important that each of the external formations is a very reliable reference point for internal structures, and any deviation from their normal development makes it possible to suspect a concomitant intracardiac anomaly.

Consider the anatomy of the heart chambers. The difficulty in describing the anatomy of these parts of the heart lies in the fact that the heart is located obliquely and, speaking of its surfaces and sides, the concepts of “upper-lower”, “anteroposterior”, “horizontal” often do not exactly correspond to the true spatial arrangement of the structures. A description will be given here of a healthy heart in its normal position in the chest; in determining the position of a particular structure, we proceed from the generally accepted principles of normal anatomy. In some cases, for practical convenience, we will consider the heart, being to the right of the patient lying on the operating table, that is, as the surgeon sees it. In this case, the upper divisions become left, the lower divisions become right. Before proceeding to the description of the anatomy of the heart, I would like to emphasize its three basic anatomical rules [Upderson R., Becker A., ​​1983] concerning the spatial relationships of the chambers to each other. First, due to the oblique orientation of the long axis of the heart, its ventricles are located more or less to the left of the corresponding atria. Secondly, the right divisions (atrium and ventricle) lie anterior to the corresponding left divisions. Thirdly, the aorta and its valve occupy a central position in the heart, the heart, as it were, wraps all its departments around the aortic bulb, which in turn is in direct contact with each of them.

Heart located in the chest between the cavities of the pleura, on the tendon part of the diaphragm. Its largest part (2/3) is located to the left of the midline, only the right atrium and both vena cava remain on the right.

Heart is a hollow four-chamber organ with well-developed muscular walls and has the shape of a somewhat flattened cone. There are three main positions of the heart: transverse (horizontal), when the angle between the longitudinal axes of the body and the heart is 55-65 °, oblique (diagonal), when this angle is 45-55 °, vertical (longitudinal), if the angle is 35-45 °.

With a brachymorphic body type (wide chest and obtuse epigastric angle), the spherical shape and transverse or oblique are more common. location of the heart. with a dolichomorphic body type (narrow chest and acute epigastric angle), a cone-shaped heart shape and its vertical location are more often observed.

Heart surrounded on all sides by the pericardium.

Blood supply to the heart. Nutrition of the heart. Coronary arteries of the heart.

Arteries of the heart - aa. coronariae dextra et sinistra, coronary arteries. right and left, starting from bulbus aortae below the superior margins of the semilunar valves. Therefore, during systole, the entrance to the coronary arteries is covered by valves, and the arteries themselves are compressed by the contracted muscle of the heart. As a result, during systole, the blood supply to the heart decreases: blood enters the coronary arteries during diastole, when the inlets of these arteries located at the mouth of the aorta are not closed by the semilunar valves.

Right coronary artery, a. coronaria dextra

leaves the aorta, respectively, the right semilunar valve and lies between the aorta and the ear of the right atrium, outside of which it goes around the right edge of the heart along the coronary sulcus and passes to its posterior surface. Here it continues into interventricular branch, r. interventricularis posterior. The latter descends along the posterior interventricular sulcus to the apex of the heart, where it anastomoses with a branch of the left coronary artery.

Branches of the right coronary artery vascularize. the right atrium, part of the anterior wall and the entire posterior wall of the right ventricle, a small portion of the posterior wall of the left ventricle, the interatrial septum, the posterior third of the interventricular septum, the papillary muscles of the right ventricle and the posterior papillary muscle of the left ventricle.

Left coronary artery, a. coronaria sinistra

leaving the aorta at its left semilunar valve, it also lies in the coronary sulcus anterior to the left atrium. Between the pulmonary trunk and the left ear, it gives two branches. thinner front, interventricular, ramus interventricularis anterior. and the larger one on the left envelope, ramus circumflexus.

The first descends along the anterior interventricular sulcus to the apex of the heart, where it anastomoses with a branch of the right coronary artery. The second, continuing the main trunk of the left coronary artery, goes around the heart on the left side along the coronary sulcus and also connects to the right coronary artery. As a result, an arterial ring is formed along the entire coronal sulcus, located in a horizontal plane, from which branches perpendicularly depart to the heart. The ring is a functional device for the collateral circulation of the heart. Branches of the left coronary artery vascularize the left atrium, the entire anterior wall and most of the posterior wall of the left ventricle, part of the anterior wall of the right ventricle, the anterior 2/3 of the interventricular septum, and the anterior papillary muscle of the left ventricle.

Various variants of the development of the coronary arteries are observed. owing to what there are various ratios of pools of blood supply. From this point of view, there are three forms of blood supply to the heart: uniform with the same development of both coronary arteries, left vein and right vein. In addition to the coronary arteries, “additional” arteries come to the heart from the bronchial arteries, from the lower surface of the aortic arch near the arterial ligament, which is important to take into account so as not to damage them during operations on the lungs and esophagus and thus not worsen the blood supply to the heart.

Intraorgan arteries of the heart:

branches of the atria depart from the trunks of the coronary arteries and their large branches, respectively, to 4 chambers of the heart (rr. atriales) and their ears rr. auriculares). branches of the ventricles (rr. ventriculares). septal branches (rr. septales anteriores et posteriores). Having penetrated into the thickness of the myocardium, they branch out according to the number, location and structure of its layers: first in the outer layer, then in the middle (in the ventricles) and, finally, in the inner one, after which they penetrate into the papillary muscles (aa. papillares) and even into the atrium -ventricular valves. Intramuscular arteries in each layer follow the course of the muscle bundles and anastomose in all layers and departments of the heart.

Some of these arteries have strongly developed layer involuntary muscles, during the contraction of which the lumen of the vessel is completely closed, which is why these arteries are called "closing". A temporary spasm of the "closing" arteries can lead to a cessation of blood flow to this area of ​​​​the heart muscle and cause a myocardial infarction.

Surgical anatomy of the coronary arteries

Widespread use of selective coronary angiography and surgical interventions on the coronary arteries of the heart in last years made it possible to study the anatomical features of the coronary circulation of a living person, to develop a functional anatomy of the arteries of the heart in relation to revascularization operations in patients with coronary heart disease.

Interventions on the coronary arteries with diagnostic and therapeutic purposes impose increased requirements on the study of vessels at different levels, taking into account their variants, developmental anomalies, caliber, angles of discharge, possible collateral connections, as well as their projections and relationships with surrounding formations.

When organizing this data, we Special attention drew on information from the surgical anatomy of the coronary arteries, based on the principle of topographic anatomy in relation to the operation plan with the division of the coronary arteries of the heart into segments.

The right and left coronary arteries were conditionally divided into three and seven segments, respectively.

There are three segments in the right coronary artery:

a segment of the artery from the mouth to the branch branch - the artery of the sharp edge of the heart (length from 2 to 3.5 cm);

section of the artery from the branch of the sharp edge of the heart to the origin of the posterior interventricular branch of the right coronary artery (length 2.2-3.8 cm);

posterior interventricular branch of the right coronary artery.

The initial section of the left coronary artery from the mouth to the place of division into the main branches is designated as segment I (length from 0.7 to 1.8 cm).

The first 4 cm of the anterior interventricular branch of the left coronary artery are divided into two segments of 2 cm each - segments II and III. The distal portion of the anterior interventricular branch was segment IV.

The circumflex branch of the left coronary artery to the point of origin of the branch of the blunt edge of the heart is the V segment (length 1.8-2.6 cm).

The distal segment of the circumflex branch of the left coronary artery was more often represented by the artery of the obtuse margin of the heart — segment VI.

And finally, the diagonal branch of the left coronary artery is segment VII.

The use of segmental division of the coronary arteries, as our experience has shown, is advisable in a comparative study of the surgical anatomy of the coronary circulation according to selective coronary angiography and surgical interventions, to determine the localization and spread of the pathological process in the arteries of the heart, and is of practical importance when choosing the method of surgical intervention in the case of coronary disease hearts.

"Surgery of the aorta and great vessels", A.A. Shalimov

Complications of penetrating injuries (life-threatening)
- hemothorax- accumulation of blood in the pleural cavity: free and encysted; depending on the size - small, medium and total;
- pneumothorax- accumulation of air in the pleural cavity: external and internal; closed, open and valve
- chylothorax- accumulation of lymph in the pleural cavity
-emphysema- air entering the tissue: subcutaneous, mediastinal

Surgery open pneumothorax
Urgent surgical closure of the chest wall wound and drainage of the pleural cavity

Primary debridement chest wall wounds
- excision of the edges of the wound (economical, only non-viable tissues)
-Suturing the wound of the chest wall:
- simple suturing (for small defects)
- intercostal sutures
- mobilization of the wound edges of the chest wall (resection of one or two ribs)
- Plastic closure of the chest wall wound

1.Plasty with a muscle flap on a leg (m.pectoralis major, m.latissimus dorsi)
2.Diaphragmopexy - pulling up and suturing the diaphragm to the edges of the wound
3. Pneumopexy - pulling up and suturing the lung to the edges of the wound
4.Multilayer porous synthetic patches

Valvular pneumothorax:
- internal
- outdoor
Complications:
- pleuro-pulmonary shock;
-shift of the mediastinum to the healthy side (compression of the lung)
- emphysema subcutaneous tissue and mediastinum (mediastinal)
Treatment:
- with internal pneumothorax - decompression of the pleural cavity and elimination of a sharp displacement of the mediastinum (first aid - puncture of the pleural cavity in the second intercostal space along the midclavicular line with a thick needle with a rubber valve; in the future - active aspiration of air through the drainage introduced in the seventh-eighth intercostal space along the middle or posterior axillary line)
- with external pneumothorax (damage to the chest wall) - primary surgical treatment of the wound with excision of the soft tissue valve and suturing the wound

lung injury
- suturing the wound - with shallow wounds on the surface of the lung
- wedge-shaped resection - with marginal damage to lung tissue
- segmentectomy, lobectomy, pulmonectomy - with a large degree of destruction

2. ^ SURGERY ON THE HEART
“I will cease to respect a surgeon who touches a person’s heart” (T. Billroth, 1890)
emergency
- surgery for heart injuries
Planned

1. Operations for congenital heart defects
2. Operations for acquired heart defects
3. Operations for coronary heart disease (CHD)
4. Operations for arrhythmias, heart tumors
5. Heart transplant
6. Artificial heart

^ HEART WOUNDS.

Types of injuries
-Non-penetrating(no endocardial injury)

Isolated myocardial injuries;
injuries of the coronary vessels;

Combined injuries of the myocardium and coronary vessels.

- Penetrating(with endocardial injury)

Damage to the walls of the ventricles and atria;
injuries combined with wounds of deep structures (heart valves, septa).

Surgical tactics
1. introduction of 1-3 liters of liquid or blood in / in or in / a jet;
2. puncture of the pericardium and removal of 100-400 ml of blood (method of Larrey, Marfan);
3. Immediate thoracotomy with suturing of the wound of the heart.

^ 4. STAGES OF THE SUITATION OF THE WOUND OF THE HEART
Online access- anterior-lateral thoracotomy in the 4th or 5th intercostal space
1. Opening the pericardium
2. Blood evacuation and simultaneous temporary hemostasis
3. Suturing the wound of the heart (atraumatic needle with non-absorbable suture; interrupted or mattress suture)
4. Sanitation of the pericardial cavity
- reinfusion of blood with large blood loss
5. Drainage of the pericardial cavity
6. Suturing the wound of the chest wall

^ SURGICAL TREATMENT OF CORONARY HEART DISEASE (CHD)
Indirect myocardial revascularization;
Direct myocardial revascularization

Mammaro-coronary anastomosis (V. Demikhov, 1952)
- mammaro-coronary anastomosis on a beating heart (V. Kolesov, 1964)
- autovenous coronary artery bypass grafting (ACS)
(R. Favaloro, 1969)

Today:

Autoarterial grafts (a. thoracica interna, a. gastroepiploica dextra, a. radialis)
Endovascular (X-ray surgery) method
transluminal balloon angioplasty (TLBA)
TLBA + stent insertion

Combination of CABG and TLBA

^ Minimally invasive surgery – performing operations on a beating heart without the use of cardiopulmonary bypass and using a minimal access (5 cm - thoracotomy or longitudinal sternotomy)

Coronary artery bypass grafting using a. thoracica interna

Operations with the use of robotics (thoracic-coronary anastomosis)

^ ARTIFICIAL HEART
Artificial heart as a "bridge" to donor heart transplantation - two-stage heart transplantation;
Artificial left ventricle - pump (up to 55 days) - Biopamp

- "Novacor" - implantation of the pump into the patient's body
- "bridge" to transplantation (87%)
- "bridge" to the restoration of heart function (9%)

Transplant alternative (4%)

^ The life of the artificial ventricle is on average 174 days (maximum - more than 3 years);
"Disadvantage" - very high price (~ 300 thousand dollars);
Perspective: implantation of an artificial left ventricle in chest next to the patient's heart - removing a significant burden from the diseased heart.

^ FEATURES OF THE SURGICAL ANATOMY OF THE ESOPHAGUS

1. Location in three anatomical regions (neck, chest, abdomen)
2. Features of the shape and position of the esophagus (narrowing, bending, spiral course in relation to the thoracic aorta)
3. Thick but easily tearable wall
4. Lack of serous cover (covered with adventitia)
5. Relatively "poor" blood supply (sufficient, but not plentiful)
6. Porto-caval anastomosis in the lower part of the esophagus

^ 8. SURGERY ON THE ESOPHAGUS

1. Esophagectomy - dissection of the esophagus
2. Resection of the esophagus

With the imposition of a cervical and gastric stoma (Dobromyslov-Torek operation)
- with the imposition of gastroesophageal or enteroesophageal anastomoses (restoration of the continuity of the digestive tract)

3. Esophagoplasty - creation of a new esophagus

^ 9. STAGES OF THE OPERATION OF RESECTION OF THE ESOPHAGUS

1. Thoracotomy
2. Mobilization of the esophagus
3. Transection of the esophagus in the n / c and suturing the distal stump
4. Removal of the esophagus
5. a - formation of esophagostomy and gastrostomy;

B - formation of esophago-gastroanastomosis;
c - formation of esophago-jejunoanastomosis;
d - esophagoplasty

10.ESOPHAGOPLASTY- creation of an artificial esophagus
According to the method of transplantation:

Antethoracic (presternal) according to Ru-Herzen-Yudin
Intrathoracic

Through anterior mediastinum(retrosternal)
- through the posterior mediastinum

Intrapleural

^ Type of transplant:

Leather
- small intestine
- stomach
- colon
- combined (gut + skin)

11. STAGES OF ANTETHORACAL ESOPHAGOPLASTY OF THE SMALL INTESTINE

1. Loop mobilization small intestine and bringing it to the neck

Laparotomy;
- mobilization of the loop of the small intestine and its intersection in the proximal section;
- formation of interintestinal anastomosis
- removal of a loop of the small intestine on the neck
- formation of gastrointestinal anastomosis (Ru-Herzen)

2. Formation of the subcutaneous tunnel
3. Formation of the cervical esophago-intestinal anastomosis (after 4-7 days)