Sansone Fabrizio, del Ponte Stefano, Zingarelli Edoardo, Casabona Riccardo
Division of Cardiac Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
Interact Cardiovasc Thorac Surg. 2011 Oct;13(4):370-2. doi: 10.1510/icvts.2011.276907. Epub 2011 Jul 27.
Use of the Foley catheter has been described in cardiac surgery over a wide range of applications. In recent years, the interest in minimally-invasive surgery has increased, providing several advantages in terms of mortality and morbidity. Unfortunately, challenging situations, such as re-do surgery may be encountered, and innovative strategies to reduce the invasiveness of the surgical approach need to be developed. External snaring of the caval veins in re-do patients is hazardous when a minimally-invasive approach is used because the tissues are usually fragile and sudden bleeding can be difficult to control. We propose a simple strategy using Foley catheters to provide 'internal snaring' of both caval veins, avoiding surgical dissection of the adhesions around the vessels. Three re-do patients were operated on for combined mitral/tricuspid surgery using internal snaring: the occlusion of the veins was satisfactory in all cases, with no complications reported so far. Even though the 'trick' described is not spectacular, it might be very helpful to be prepared to use this technique either on a routine basis or in special situations when the risk of injury to the atrial or caval structures appears to be increased.
Foley导管在心脏手术中的应用已被广泛描述。近年来，对微创手术的兴趣有所增加，这在死亡率和发病率方面具有诸多优势。不幸的是，可能会遇到诸如再次手术等具有挑战性的情况，因此需要制定创新策略以降低手术入路的侵入性。在再次手术患者中，当采用微创入路时，腔静脉的外部圈套术是危险的，因为组织通常很脆弱，突然出血可能难以控制。我们提出一种使用Foley导管的简单策略，对两条腔静脉进行“内部圈套”，避免对血管周围粘连进行手术解剖。三名再次手术患者接受了二尖瓣/三尖瓣联合手术，采用内部圈套术：所有病例中静脉闭塞情况良好，目前尚无并发症报告。尽管所描述的“技巧”并不惊人，但无论是常规使用还是在心房或腔静脉结构损伤风险似乎增加的特殊情况下准备使用该技术，可能都会非常有帮助。
