Page 202 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 15 · Surgery of the heart, pericardium and great vessels

to 8 minutes of TVIO. In dogs with diseased hearts, the Total cardiac outflow occlusion
permissible time for complete occlusion may be reduced. TCOO is usually achieved by placing a straight vascular
VetBooks.ir to perform TVIO for as short a period of time as is neces- clamp from the left side of the chest, across the main
The objective, in the scenarios presented in this chapter, is
pulmonary artery and the aortic root simultaneously. This
sary to achieve haemostasis using vascular clamps. Once
manoeuvre is achieved by opening the pericardium
the vascular clamps are in place, TVIO is concluded and
blood circulation restored. The author’s tip for using directly ventral to the left phrenic nerve such that one jaw
Rummel snares is to make the tubing that creates the of the vascular clamp passes across the base of the heart
snare long enough to be ‘out of the way’ once the snare is via the transverse pericardial sinus and the more cranial
clamped (Figure 15.1). jaw of the vascular clamp passes cranial to the pulmonary
artery and aorta so that closing the jaws occludes them
at the same time. This manoeuvre, in combination with
traction on the aortic noose (see the section on PDA),
should stop blood flow from a torn ductus, for example,
sufficient to allow the placement of haemostatic vascular
forceps. Again, occlusion time should be kept as short as
is pos sible (Figure 15.2).

(a)

(a)

(b)

(c)
(b)
(a) In this dog with cor triatriatum dexter, thick (3.5 metric
15.1
(0 USP)) silk has been placed around the cranial vena cava a The vie of the heart and pericardium via a left fourth
CrC a ygos vein and caudal vena cava CdC via a right fifth 15.2 intercostal thoracotomy in a 1.4 kg dog with patent ductus
intercostal approach. ach silk suture passes through a length of rubber arteriosus. An incision has been made in the pericardium ventral to the
tubing to make a ummel snare in preparation for total venous phrenic nerve revealing the pulmonary artery trunk . The vagus
inflo occlusion. ericardial basket sutures keep the lung out of the nerve and aorta o are also visible. b The closed otts forceps F
surgical field. b The snares are tightened and held in place by clamps on are passing across the transverse pericardial sinus T isolating the
the silk suture as it e its the rubber tubing out of photograph to arrest aortic and pulmonary artery roots hich lie cranially. If bleeding occurs
venous inflo and allo intracardiac manipulations. The fibromuscular during dissection, a straight vascular clamp with the caudal jaw passing
band dividing the right atrium, which is to be resected, can be seen (B). across the T and the cranial a cranial to the aorta allo s total
(c) Once the atrium is sealed by the vascular (Satinsky) clamp, the snares cardiac outflo occlusion to be achieved. long ith traction on the
are released and the circulation of blood resumes. The atrial incision is aorta, this manoeuvre should allow time to place a haemostatic vascular
closed ‘inside’ the clamp. clamp across the bleeding ductus.

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