Then the cannulas and the catheter are placed, cardiopulmonary bypass is commenced (venous deoxygenated blood arriving to the heart is forwarded to the CBP machine to get oxygenated and delivered to aorta to keep rest of the body saturated, and often cooled to 32 - 34 degrees celsius in order to slow down the metabolism and minimize as much as possible the demand for oxygen. A clamp is placed on the Aorta between the cardioplegic catheter and aortic cannula, so the cardioplegic solution that the flow is controlled by the surgeon that clamps Aorta. Within minutes, heart stops beating. Anastomosis (grafting)With the heart still, the tip of the heart is taken out of pericardium, so the native arteries lying in the posterior side of the heart are accessible. Usually, distal anastomosis are constructed first (first to right coronary system, then to the circumflex) and then the sequential anastomosis if necessary. Surgeons check the anastomosis for patency or leaking and if everything is as it should be, surgeons insert the graft within the pericardium, sometimes attached to the cardioplegic catheter. The anastomosis of LIMA to LAD is usually the last one of the distal anastomoses to be constructed, while it is being constructed the rewarming process starts (by the CPB).. After the anastomosis is completed and checked for leaks, the proximal anastomoses of the conduits, if any, are next.
Factitious dermatitis, also known as dermatitis artefacta, is a form of factitious disorder in which patients will intentionally feign symptoms and produce signs of disease in an attempt to assume the patient role. It is also self-inflicted skin damage, most commonly from prolonged deliberate scratching, but sometimes by means of sharp instruments or another agency. : 391 : 61

See also
List of cutaneous conditions

References


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