Lmb

Vagus and recurrent laryngeal nerves

figure 28-5 Intrapericardial hilar release, from outside of the pericardium, A and B. A, A U-shaped incision (dashed line) is made around the inferior pulmonary vein (IPV) after dividing the (inferior) pulmonary ligament. The phrenic nerve must not be injured. B, The frenum between the pericardium and epicardium beneath the IPV has been divided, allowing elevation of the hilum, as shown. The dashed line indicates extension of the pericar-dial incision around the hilum to achieve further mobility. C, Release of the IPV via wide pericardiotomy, accomplished through complete median sternotomy from inside the pericardium. Technique of Cameron D. Wright. The line of pericardial incision (dashed line) anterior to the pulmonary vein must be close to the vein in order to avoid injury to the phrenic nerve, which lies quite close to the vein outside of the pericardium. LMB = left main bronchus.

Left auricle

Left atrium

Pulmonary artery

Left ventricle

Coronary

Inferior pulmonary

Left auricle

Left atrium

Pulmonary artery

Left ventricle

Coronary

Inferior pulmonary

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