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4-11) without placing a partial occluding clamp on the atrium. The cannula is then inserted and the purse-string suture snugged. Cannulation Figure 4-9 Figure 4-10 Figure 4-11 29 Preparation for Cardiopulmonary Bypass Figure 4-13 Figure 4-12 Figure 4-14 Caval tapes can be placed before or after caval cannulation. The superior vena cava is encircled by incising the pericardial tissue medial to the superior vena cava over the right pulmonary artery. This opens the plane behind the superior vena cava.

The structure of irreversibly injured cells following 60 min of ischemia showed absence of glycogen, margination of nuclear 48 Normothermic Ischemic Arrest chromatin, marked mitochondrial swelling with disruption and fragmentation of cristae, decrease in mitochondrial matrix density, and development of amorphous densities in the mitochondrial matrix (Fig. 6-3). Other investigators have described similar findings regarding the ultrastructural changes of irreversibility or lethal cell injury. 24,114,116 Figure 6-1.

An esophageal temperature of 27°-29°C is reached after about 30 min of surface cooling. At an esophageal temperature of about 29°C the ice packs are removed and the usual sterile preparations for incision are made. Sternotomy is usually performed at a temperature of about 2rc. Cannulation is performed with a single right atrial cannula and a cannula in the ascending aorta. Bradycardia is common at the time of cannulation, but ventricular arrhythmias are uncommon. If ventricular fibrillation does occur, it can usually be reversed with electroconversion.

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