Pulmonary resection

The resection of the pulmonary veins with the area of ​​the left atrium with the right-sided localization of the tumor is much technically more difficult and dangerous, due to the peculiarities of their anatomical structure. Short, slow-moving, especially during germination with tumor tissue, deeply located, flowing into the atrium on the posterior surface, they are usually inaccessible to the typical treatment with separate ligation of the vessels. Ligation as a wide thin-walled common venous trunk represents a significant risk due to the possibility of its ligature erupting. It is preferable to apply a mechanical eyelet stitcher directly to the atrium and to apply here stitching seams. If local spread of the tumor allows, in order to increase the reliability of the sutures, even before the vessel is cut off, it is somewhat proximal, 3 mm away from their first line, imposing a second one. Additional reinforcement for such resection does not require double mechanical hardware seam and is quite reliable. When performing atrial resection from the right-sided access using mechanical stitching apparatus, it is necessary, by superimposing the apparatus, to control the location of the interatrial sulcus of the heart and to flush the left atrium posterior to it. Involvement of the interatrial septum and a section of the anterior wall of the right atrium into the suture can lead to serious violations

heart rhythm and even to mechanical narrowing of the mouth of the superior vena cava.

Suturing the left atrial wall for right-side resections with manual sutures is difficult and dangerous. Performing a well-adapted manual suture requires the prior application of a vascular clamp (such as the Satinsky clamp) and the intersection distal to its atrium wall. With constant traction behind the clamp during the suture, a rupture or slipping from the clamp branch of the thin and mechanically fragile posterior wall of the atrium can occur, resulting in massive, very difficult to stop bleeding.

When such a complication arises, it seems to us expedient to abandon attempts to capture the damaged atrium in the depth of a wound filled with blood, with the help of a vascular clamp, as this may lead to an increase in the rupture and increased bleeding. It is necessary to press the atrial wall to the spine with a tupfer to temporarily stop or at least reduce bleeding, dry the operative field, and then suture the atrial defect with a blanket or furrier continuous seam, always taking a section of the dissected pericardial leaf into the seam together with the posterior atrium. Pericardium, acting as a gasket, avoids the eruption of the seams. Summing up in such a situation to the posterior wall of the atrium of other auto or alloplastic materials is extremely difficult.

Resection of the left atrium from the left-side access can be equally successfully performed using either a hardware mechanical suture or manual suture. Hand seam impose using atraumatic synthetic threads. In a number of cases, you can use a combination of two techniques, manual reinforcement of mechanical seams.

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