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European Journal of Cardio-Thoracic Surgery, Vol 7, 158-162, Copyright © 1993 by European Association for Cardio-thoracic Surgery

ARTICLES

Dilation of the internal mammary artery by external papaverine application to the pedicle--an improved method

E Dregelid, K Heldal, KS Andersen, L Stangeland and E Svendsen
Department of Heart Disease, Haukeland Hospital, Bergen, Norway.

Spasm of the internal mammary artery (IMA) during coronary bypass grafting may cause inadequate graft flow and makes accurate placement of sutures difficult. In addition, IMAs with poor intraoperative flow rates are more likely to occlude. In this study three methods for spasm prevention were compared in 51 patients undergoing coronary bypass surgery. In group 1, IMA pedicles were covered with a sponge soaked with papaverine solution (0.8 mg/ml of papaverine in 0.9% saline) and left intact distally, thus allowing continuous blood flow until used for bypass. In group 2, the IMAs were divided and clamped distally and the pedicle tucked into a papaverine-soaked sponge. In group 3, the IMAs were also divided distally, clamped, and placed under the upper sternum submerged in papaverine solution (0.8 mg/ml) inside a surgical glove. Free flow from the IMA was higher in group 3 than in groups 1 and 2 (60 ml/min vs. 44 and 30, respectively, P < 0.03). Morphometric measurements disclosed a larger luminal area and less folding of the internal elastic lamina in group 3 compared with groups 1 and 2 (0.73 mm2 vs 0.33 and 0.37, respectively, P < 0.03). Submersion in papaverine solution thus provides better procurement of IMA grafts than storage of the pedicle in a papaverine-soaked sponge.

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				D. S. Girard, J. P. Sutton III, T. H. Williams, A. J. Crumbley III, J. L. Zellner, J. M. Kratz, and F. A. Crawford Papaverine Delivery to the Internal Mammary Artery Pedicle Effectively Treats Spasm Ann. Thorac. Surg., October 1, 2004; 78(4): 1295 - 1298. [Abstract] [Full Text] [PDF]

				E. Dregelid, K. Heldal, F. Resch, L. Stangeland, K. Breivik, and E. Svendsen Dilation of the internal mammary artery by external and intraluminal papaverine application J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 697 - 703. [Abstract] [Full Text]