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J Thorac Cardiovasc Surg 2006;132:1246
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Inflow occlusion in the era of modern cardiac surgery

Jaswinder Singh, MCh, Rajinder S. Dhaliwal, MCh, Suvakanta Biswal, MS, Naveen Swami, MS

Department of Cardiovascular & Thoracic Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India

To the Editor:

We read with interest the article titled "Inflow Occlusion Pulmonary Embolectomy in the Modern Era of Cardiac Surgery" by Bobadilla and associates.1Go The following points are not clear from the contents of the article.

First, how was the core temperature lowered? Was it lowered with a cooling blanket or just by dropping the temperature of the operating theater, and how long did it take for the temperature to drop to 32°C?

Second, for what duration was the inflow occluded?

Absence of structural or functional damage to the brain has been noted during circulatory arrest. Probability of safe circulatory arrest according to degree of hypothermia is shown in Table 1.


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  		TABLE 1. Probability of safe circulatory arrest according to hyperthermia
 
There are a number of situations wherein familiarity with inflow occlusion technique may be of use, such as pulmonary valvotomy, aortic valvotomy, and atrial septectomy. Patients who have pulmonary atresia with intact septum can undergo relief of right ventricular outflow tract obstruction with a patch, pulmonary valvotomy, or a Brock procedure. Other procedures that have been performed safely by this technique are tricuspid valvectomy, emergency perforation of a ventricular septal patch, obtaining full thickness myocardial biopsy, and repair of penetrating wounds of the heart.2Go

Undoubtedly, this technique represents a considerable cost savings over the same procedures performed with cardiopulmonary bypass. In the current economic era of limited health care budget, any surgical technique that provides equivalent results is to be preferred over more expensive alternatives.

References

  1. Bobadilla JL, Wigfield CH, Chopra PS. Inflow occlusion pulmonary embolectomy in the modern era of cardiac surgery. J Thorac Cardiovasc Surg 2006;131:484-485.[Free Full Text]
  2. Jonas RA, Castaneda AR, Freed, MD. Noromothermic caval inflow occlusion; application to operations for congenital heart disease. J Thorac Cardiovasc Surg 1985;89:780-786.[Abstract]

Related Article

Reply to the Editor
J.L. Bobadilla, C.H. Wigfield, and P.S. Chopra
J. Thorac. Cardiovasc. Surg. 2006 132: 1246-1247. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


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 Eur J Cardiothorac SurgHome page
O. Gokalp, I. Yurekli, L. Yilik, S. Bayrak, T. Goktogan, E. Arikan, U. Yetkin, and A. Gurbuz
Comparison of inflow occlusion on the beating heart with cardiopulmonary bypass in the extraction of a mass lesion or a foreign body from the right heart
Eur J Cardiothorac Surg, May 1, 2011; 39(5): 689 - 692.
[Abstract] [Full Text] [PDF]

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