Note 27 — Chapter XXIX · SURGICAL DISEASES OF THE HEART AND VASCULAR SYSTEM.

Sheen (Annals of Surgery, July, 1905) reports a successful case, his method being as follows: Median incision from the cricoid to one inch below the sternal notch, exposure of the carotid and innominate, then a silk ligature carried around the innominate distally and tied with Balance’s stay-knot; pulsation ceased, to later reappear. A second similar operation also failed. A third operation was performed through a five-inch transverse incision above the clavicle, the artery being twice ligated proximally. Sheen advises that ligature should always be of silk, that the incision should be central, with horizontal and vertical division of the manubrium; that the carotid should also be tied; that two ligatures be placed; that drainage is inadvisable, and that next to sepsis as a cause of death stand cerebral lesions. Statistics are thirty-six cases of ligature, with a mortality of 78 per cent.