[[700 Technical Outline of Repair of Aortic Dissection]] # Cross Clamp (Aortic Dissection) - By the time the heart begins to fibrillate and distend because of the aortic insufficency overcoming the LV vent, you should have separated the Aorta and the Pulmonary Artery sufficiently to permit aortic cross clamping - If direct cannulation was used, you would preferably apply the clamp proximal to the cannulation (obviously) and distal to the level of the crossing of the right pulmonary artery underneath the aorta - In all other cannulation strategies, apply clamp distal the the level of the crossing of the right pulmonary artery underneath the aorta - Unlike other situations where the Fogarty Hydrogel Clamp is applied to three "clicks" of the ratchet that holds the jaws together, go further here, and consider going to the maximum - You will be resecting this portion of the aorta, so you don't have to worry about endothelial damage - If you don't clamp more tightly than normal, when you transect the aorta, you will find that blood is still making its way past the clamp into your field - I believe this occurs because the thicker intima is no longer united to the adventitia, so the cross clamp occludes the tube of intima, but by separating the jaws of the clamp, prevents complete occlusion of the adventitial tube - I've occasionally had to put two cross clamps on to control this![[Cross Clamp in Aortic Dissection.jpg]]