Further, referring scissors

Further, referring scissors in an ascending aorta, dissect its left wall. In the field of an aortic arch scissors turn a little to the left and cut its forward wall (fig. 39 see). Then dissect a descending aorta for what it is necessary to raise heart for the organs of a mediastinum skelaxin health taken in the left arm. At such order of opening cut the left valve of the aortal valve. To avoid it, A.I.Abrikosov recommends an aorta from a trunk of a pulmonary artery and, having delayed it to the right to make a cut more to the right from specified above a place. At a section ascending ' willy-nilly it is necessary to cross the pulmonary artery already opened and examined. To avoid it it is possible only at preliminary a pulmonary artery and its branches from an aorta and their procrastination to the right at aorta opening. If at opening of a pulmonary artery find out open a duct and wish to keep it on all extent dissect only forward wall of a left ventricle, a cone of an aorta and its valval ring.
Having left a part of an ascending aorta not opened, make cuts a scalpel a forward wall of an aorta above places and from here scissors conduct an aortic arch cut as it is possible more close to its convex surface. At aortic aneurysms it dissect whenever possible voltaren health so that aneurysm has stood aside of a cut and it would not be damaged. After a cut for aorta opening on a forward wall of a left ventricle the triangular flap with an apex turned downwards is formed. This flap throw back to the left and then the aorta cone, its valves ' And a cavity of an ascending aorta open. Here it is recommended to pay special attention on sine (sinus Valsalvae), places othozhde-nija coronal arteries and large vessels, a confluence place a duct and a place of an isthmus of an aorta (isthmus aortae). The spent four cuts (fig. 39 see), . , two on external edges of the right both left ventricles and two on a forward surface for opening of a pulmonary artery and an aorta, completely open heart cavities (A.I.Abrikosov, 1948). Exist also other methods of opening of heart, but, in our opinion, the method of opening of heart resulted earlier at cautious and its circumspect application is the most simple, accessible and evident. Having finished the research, all organs clean with a little table that they did not stir to the further work, and put in a corpse or leave for a museum '. Method of measurement of the area of valval apertures of heart Necessity of measurement of the area of valval apertures of heart for square centimetres has ripened for a long time already, and in connection with heart surgery development (valvulo-tomija, the commissurotomy) has increased to a pressing need both at pathoanatomical openings, and at operations.
Definition of the area, valval apertures of heart under rather difficult formulas Carlotti or Qorlin 1 Opening of heart at its congenital defects is resulted in chapter 10 (p. 179), devoted to opening of corpses newborn and mortinatus at which such defects are observed in most cases. 144 Demands application of difficult techniques, it is technically difficult , and in pathoanatomical practice and it is not so applicable. Rational method of measurement of the area of valval apertures of heart in square centimetres in pathological anatomy it was offered nobody. Traditionally not only pathologists, but also surgeons measure an aperture by fingers. It is considered normal if the right atrioventricular etodolac health aperture passes three fingers, and left two. A way very convenient and simple, but absolutely inexact as different there are fingers and different hearts. Therefore still V.P.Krylov in 1877, translating management , has added: ... A moderate man's arm . Thus it is not defined neither the area, nor aperture perimetre. More exact and objective recognise measurement of a circle (perimetre) of apertures by a millimetric ruler on the opened and developed heart on a line valves from a fibrous ring. But it can be made at normal valves. At stenoses measurement by a ruler becomes rather inconvenient, and at times and impossible. It is possible to measure perimetre of an aperture in such cases with the help parts along the edges of valves, and then to summarise, or by means of a thin zinc, lead or silver wire, carefully modelling it along the edges of valves, and then straightening it and measuring by a ruler. Work this, rather laborious, demanding the big attention, patience and time, is not justified because on one perimetre it is impossible to define the area of actual disclosing of a valval aperture. It is possible to define only the circle area if aperture perimetre to accept for a circle. But apertures and in norm have no circle form. There was an opinion to make the standard - a criterion in the form of a cone with the divisions, allowing to define and length of perimetre of an aperture, and its area. However at an adnation of valves, them between a cone and aperture edges there are clefts. Moving a cone closely with effort, it is possible to deform an aperture and to receive an artefact, let alone that will be thus broken not only fresh applyings on (wart) valves, but also old. 10 Pathoanatomical technicians 145 I.K.Yesipov (1958, etc.) was calculated by the mitral orifice area as corresponding to the most suitable geometrical figure. It difficultly enough and rather is not exact. Easier and more precisely to take out the aperture form on a transparent plate from plexiglass, celluloid and so forth, having outlined on it perimetre of an aperture ink. Then a plate with taken out apertures to impose on graph paper and on it to count up the area. There was still an opinion - to photograph an aperture (one to one), but it is even more difficult, demands change of a method of opening of heart and a lot of time.