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Ann Thorac Surg 2006;81:1945
© 2006 The Society of Thoracic Surgeons

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Correspondence

Papaverine Dissection for Harvesting Internal Mammary Artery

Department of Cardiothoracic Surgery, Leeds General Infirmary, Great George St, Leeds, LS1 3EX United Kingdom

(Email: unnikrishnan.nair{at}leedsth.nhs.uk).

To the Editor:

We read with great interest the article by Saxena and colleagues [1]. The authors used saline to raise endothoracic fascia from the internal thoracic artery (ITA) and also the ITA from its bed. In 1991 John and associates [2] described the injection of normal saline between the costal cartilages and adjacent tissue for separating ITA from the chest wall as a technique for dissecting ITA with reduced surgical trauma. We presented a new technique in The Annals of Thoracic Surgery in 1997 [3] describing the use of dilute papaverine for hydro-dissection of the mammary artery. From 1994 onward we have used this technique for harvesting approximately 2,000 mammary arteries and have noticed consistently favorable results in terms of reduced vasospasm, short harvest times, and increased accessibility for dissection.

Papaverine is one of the many vasodilator agents commonly used topically for reducing perioperative vasospasm of the mammary artery. In our technique, as papaverine is injected, even before dissection is started, it dilates the artery and makes it less prone to spasm at the time of harvest. Papaverine's action is optimal at 37°C [4] and infiltration around the ITA at the beginning allows it to act at body temperature until full length of the pedicle has been mobilized. This avoids the need for using topical cold papaverine solution. We prefer topical to intraluminal papaverine as the acidic pH has been shown to damage the endothelium of the internal mammary artery [5]. We would recommend our technique in thoracoscopic dissection of the mammary as well for its beneficial effects.

	References

Top References

 

1. Saxena P, Mejia R, Tam R. Hydrodissection technique of harvesting left internal thoracic artery Ann Thorac Surg 2005;80:355-356.[Abstract/Free Full Text]
2. John LCH, Edmondson SJ, Rees GM. Modified technique of internal mammary artery harvest Ann Thorac Surg 1991;52:157-158.[Abstract]
3. Mulay AV, Dev KK, Nair UR. Prevention of internal thoracic artery spasm Ann Thorac Surg 1997;64:564.[Abstract/Free Full Text]
4. Bilgen F, Yapici MF, Serbetçiolu A, Tarhan A, Çoruh T, Özler A. Effect of normothermic papaverine to relieve intraoperative spasm of the internal thoracic artery Ann Thorac Surg 1996;62:769-771.[Abstract/Free Full Text]
5. Cooper GJ, Gillot T, Parry EA, Kennedy A, Wilkinson GA. Papaverine injures the endothelium of the internal mammary artery Cardiovasc Surg 1995;3(5):553-555.[Medline]

This article has been cited by other articles:

				P. Saxena and R. Tam Reply. Ann. Thorac. Surg., May 1, 2006; 81(5): 1945 - 1946. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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): Unnikrishnan R. Nair Kalyana Javangula Anvay V. Mulay Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nair, U. R. Articles by Mulay, A. V. Search for Related Content PubMed PubMed Citation Articles by Nair, U. R. Articles by Mulay, A. V. Related Collections Coronary disease Related Article