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- Title
THE CURRENT STATUS OF THE INTERNAL MAMMARY IMPLANT OPERATION.
- Authors
Baird, Ronald J.; Goldbach, Martin M.; De la Rocha, Alberto G.
- Abstract
A patent implant must be clearly differentiated from a useful functional implant. The physiological factors which allow continued patency are different from those which determine whether or not it will become functional. Patency is dependent upon to and from shunting of blood in and out of the tunnelled portion of the implant. Implants may remain patent without developing any significant implant to coronary anastomoses. An implant which remains patent but does not develop significant implant-coronary anastomoses is a useless implant. Implant to coronary anastomoses result from the dual blood supply of the granulation time in the healing myocardial tunnel. The initial small capillary connections from the implant to the coronary arteries will enlarge and become direct channels if exposed to a significant pressure gradient. There are three known reasons for a pressure gradient: one is present in every implant, one is dependent on the location of the myocardial tunnel, and one is dependent on the design of the tunnel. The correct location of the implant is determined from the angiography of the coronary arteries. The correct design of the tunnel requires that its central or deepest portion be at least as deep as the middle third of myocardium so that during systole the pressure within the implant will be exceeded by the local tissue pressure of the contracting myocardium. The systolic occlusion of the deepest portion of the implant is easily visible on follow-up angiograms. It leads to the presence of supra-systolic pressure in the distal third of the implant, and has been a constant finding in all the highly successful implants of several different surgeons. With appropriate location and design of the tunnel, the surgeon should achieve a high percentage of functional implants. With appropriate care, there is reason to believe that implants and aorto-coronary bypasses can be performed concurrently with success.
- Subjects
ARTIFICIAL implants; PORTACAVAL anastomosis; CARDIAC contraction; ANGIOGRAPHY; SURGEONS
- Publication
Vascular Surgery, 1975, Vol 9, Issue 5, p273
- ISSN
0042-2835
- Publication type
Article
- DOI
10.1177/153857447500900503