Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3753_Библиотеки_им_академика_М_И_Перельмана

patch and our preferred choice is a bovine peri­cardium though there are increasing reports of excellent results with newer materials which are more supple and easier to handle through a small incision. (See Video 2). Once the defect is closed the left lung is bagged and any flow from left to right is looked for. Occasionally an extra mat­tress suture is required to control the area where flow is identi fied. Minor suture bleeding is accepted as these do not lead to any significant shunts. After the right atrium is closed with a continue suture technique and reinforced with a second layer we routinely fill the heart to rule out any areas that need further sutures. If the atrial tissue is thinned out pericardial reinforced sutures are used and rarely haemo stat agents may be necessary to control needle point bleeding. A drain is left within the pericardium prior to using three interrupted sutures to appose the pericardium prior to weaning off the bypass machine. Both lungs are then reinflated prior to weaning off cardiopulmonary bypass as poor oxygenation is detrimental to right ventricular function and should be avoided. Once the patient