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Membrane Optic Capture

Membrane Optic Capture

Video shoves replacement of a dislocated IOL. Video by Howard Gimbel, MD.

ECG Case: STEMI in a young patient

ECG Case: STEMI in a young patient

Watch this video to see the changes in serial ECGs of a young patient with chest pain and the final diagnosis of a MI. Remember: lead aVL can show early reciprocal changes from an inferior MI before ST-elevation

Repositioning A Dislocated IOL Via  Pars Plana Approach

Repositioning A Dislocated IOL Via Pars Plana...

Video showes optic capture of a dislocated IOL. IOL subluxed into the vitreous through posterior capsule tear.

ECG Case: Atrial Septal Defect

ECG Case: Atrial Septal Defect

ECG findings of atrial septal defects: -1st degree AV Blocks -Atrial Dysrhythmias -Incomplete RBBB -Signs of right atrial enlargement -Notching of the S-waves in the inferior leads (“Crochetage” pattern) - very specific

Creation of Composite Y-graft with Bilateral Internal Mammary Arteries for Coronary Grafting

Creation of Composite Y-graft with Bilateral...

This video shows the technique of composite Y-graft creation with internal mammary arteries (IMA) for bilateral IMA coronary grafting operation. This is performed before going on bypass. Right internal mammary artery (RIMA) is harvested as a skeletonized free graft and left internal mammary artery (LIMA) is harvested as a skeletonized pedicled graft. The skeletonization is important to provide a good length of the grafts and avoid sternal infection. Since the heart is full and not arrested the precise marking of the Y-graft anastomosis site on the LIMA is possible. This site is marked on the LIMA at the level of left atrial appendage. The proximal end of right IMA is anastomosed to the marked site of the left IMA (end-to-side anastomosis) using continuous 8-0 Prolene suture. The blood flow in the Y-graft is measured to make sure that it is about 3 times more than the flow in the LIMA (measured before) to be able to provide good blood supply to 2 and more coronary arteries bypassed. The composite Y-graft is now ready for BIMA coronary grafting.



Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with bowel resection for advanced endometriosis using a "dental floss dunk" technique.

Coronary Artery Grafting with Bilateral Internal Mammary Arteries Using Y-Graft Technique

Coronary Artery Grafting with Bilateral Internal...

The right internal mammary artery (RIMA) is harvested as a skeletonized free graft first and then the left internal mammary artery (LIMA) is harvested as a skeletonized pedicled graft. The site of Y-graft anastomosis is marked on the LIMA at the level of the left atrial appendage and the proximal end of the RIMA is anastomosed to the LIMA at the marked site before going on bypass. The composite Y-graft is now ready. The patient is cannulated and the bypass is started. The Diagonal artery and LAD are grafted using LIMA sequential graft and the OM and PDA are grafted using the RIMA sequential graft for this particular patient. 64 slice contrast CT scan is used for grafts patency control 3 moths after surgery. Dupplex control also can be used to assess the blood flow in LIMA stem with dominant diastolic component.

Coronary Angiogram 5 years after BIMA Coronary Grafting

Coronary Angiogram 5 years after BIMA Coronary...

Bilateral IMA coronary grafting was performed on this 32 years-old diabetic patient using Y-graft technique along with one vein graft. CABGx5 was performed with the following coronaries grafted: LIMA to Diagonal and LAD (sequential); RIMA to OM1 and PDA (Sequential) and SVG to OM2 graft. This coronary angiogram 5 years after surgery shows patent SVG to OM2 graft and patent composite BIMA Y-graft. Good feeling of Diagonal and LAD from LIMA and OM1 and PDA from RIMA is seen.

Vahe Gasparyan Method of Total Autologous Reconstruction of Mitral Valve

Vahe Gasparyan Method of Total Autologous Reconstruction...

I have developed the method of intra-operative tailoring of the pericardial patch for the total reconstruction of mitral valve. This method is based on the morphometry performed on cadavers hearts. I have found strong relationships between mitral valve fibrous annulus and leaflets parameters (“Total Reconstruction of the Mitral Valve with Autopericardium: Anatomical Study” Asian Cardiovasc Thorac Ann. 2002 June; 10 (2): 137 - 140). This experimental study video shows the total autologous reconstruction of mitral valve using my method of pericardial patch tailoring. The method is very simple, reproducible and precise. All the surgeon will need is to have the molds of different sizes (28, 30, 32, 34, 36, 38) depending on the mitral valve fibrous annulus size to tailor the pericardial patch intra-operatively. This operation could be a good alternative for the mitral valve replacement if the repair is not possible and the replacement is not desirable (especially in children with rheumatic disease). It is a stentless autologous valve.


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Head, Microsurgery Training, Dept. of Plastic Surgery Cleveland Clinic

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International Federation of Oto-Rhino-Laryngological Societies