HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshito Inoue Toshihiko Ueda Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Inoue, Y. Articles by Ueda, T. Search for Related Content PubMed PubMed Citation Articles by Inoue, Y. Articles by Ueda, T. Related Collections Related Article

J Thorac Cardiovasc Surg 2007;134:545
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Central cannulation in acute aortic dissection repair

Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan

To the Editor:

We read with great interest the article by Reece and coworkers¹ on central cannulation for acute aortic dissection. We have also experienced the safety and the advantages of this technique, which we have routinely applied to 37 patients.²

The authors limited the application of this technique to one third of their patients. However, we think it could be routinely applied for type A dissection, as far as true channel antegrade perfusion is firmly established. There seem to be three prerequisites to establish reliable true channel perfusion invariably: safe cannulation, confirmation of true channel cannulation, and confirmation of antegrade true lumen perfusion.

First, safe cannulation with the Seldinger technique requires decompression of the cannulation site in advance, which could be induced pharmacologically, by insertion of femoral inflow, or by blood drainage from right atrial cannulation. In addition, a thin-walled flexible cannula with a spindle-shaped obturator and tapered dilators is indispensable.

Second, epiaortic ultrasound imaging helps to confirm the position of the tip of the cannula within the true lumen of the proximal arch. Epiaortic ultrasound provides more detailed information on the ascending aorta and proximal arch than does transesophageal echocardiography.³

Third, epiaortic color Doppler imaging provides real-time direct information on dynamic flow inside the false and true channels, which is effective for the assessment of antegrade perfusion via true lumen.

We congratulate Reece and colleagues on their outstanding results.

References

1. Reece TB, Tribble CG, Smith RL, Singh RL, Stiles BM, Peeler BB, et al. Central cannulation is safe in acute dissection. J Thorac Cardiovasc Surg 2007;133:428-434.[Abstract/Free Full Text]
   
2. Inoue Y, Ueda T, Taguchi S, Kashima I, Koizumi K, Takahashi R, et al. Ascending aorta cannulation in acute type A aortic dissection. Eur J Cardiothorac Surg 2007;31:976-979.[Abstract/Free Full Text]
   
3. Eltzschig HK, Kallmeyer IJ, Mihaljevic T, Alapati S, Shernan SK. A practical approach to a comprehensive epicardial and epiaortic echocardiographic examination. J Cardiothorac Vasc Anesth 2003;17:422-429.[Medline]
   

This article has been cited by other articles:

				Y. Inoue Reply to the editor. J. Thorac. Cardiovasc. Surg., August 1, 2011; 142(2): 480 - 480. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshito Inoue Toshihiko Ueda Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Inoue, Y. Articles by Ueda, T. Search for Related Content PubMed PubMed Citation Articles by Inoue, Y. Articles by Ueda, T. Related Collections Related Article