this video demonstrates resection of a
cardiac paraganglioma in a 40 year old
female this paraganglioma involved her
aortic root in pulmonary root including
the left main coronary artery
she had a needle biopsy done at an
outside Hospital and almost bled to
death requiring emergency sternotomy
prior to our paraganglioma resection
around a month ago she underwent the
following mentioned procedure at our
institution
reduced and not me was performed in
dense pericardial adhesions were taken
down the tumor can be seen overlapping
the right atrium in right ventricle
descending aorta aortic arch and right
at him were dissected free to cannulate
the patient was happy nice high otech
cannula was then placed in the distal
IATA cart and single venous cannula in
the right atrium your pulmonary bypass
was then initiated the right superior
pulmonary vein was then can you get it
with the right angle sum and antegrade
cardioplegia needle Sam was then placed
in the ascending aorta and secured in
place with a 4 o prolene
this was followed by IATA cross-clamping
distal iota was completely divided this
was done so we could get to the tumor
behind iota as well as the pulmonary
artery just proximal to the bifurcation
the right coronary button had been taken
with the tumor it was like ated
proximally the left coronary button was
mobilized in the left main proximal in
proximal led could be dissected free of
the tumor preserving the left side of
circulation the finger was put to the
pulmonary valve the interior art we
could be open beyond where the tumor was
involved the rest of the pulmonary route
could then be dissected free so that the
tumor io tech and pulmonary roots are
removed in block antegrade cardioplegia
solution was then given through the left
main coronary but once this was done a
23 Edwards Magna pericardial valve was
placed inside a 26 millimeter well selva
graft in sutured with a 4 o chrony
interrupted to work pledgeted Tricon
were placed on the aortic side as an
Euler sutures the wealth conduit
proceeded and tied a running for o
prolene was placed around the base of
this for extra hemostasis an opening was
then made in this graph and the left
coronary artery was sutured with a graft
with a 5 or prolene suture in a
running fashion Telegraph's were then
brought up the pulmonary artery was
transected in the ILO graph was sewn in
an end-to-end fashion to the patient's
pulmonary artery with a fiber running
prolene suture the proximal was done
with a faux rope prolene suture
evacuating all air prior to completing
the suture line the distal Dacron graft
was then cut to the aorta and secured in
place with running 4o prolene evacuating
all air prior to completing the suture
line ascending IO tech to right coronary
artery bypass was also performed as
shown in this video demonstrating
complete IO take route pulmonary roof
replacement as well