How to Do ItOptimizing Mitral Valve Exposure With Conventional Left Atriotomy
Section snippets
Technique
The mitral valve is in fibrous continuity with the aortic valve and orientated vertically. For optimum exposure the heart is elevated out of the chest and rotated, allowing the apex to drop posteriorly while elevating the right side of the heart (Fig. 1). This brings the valve into the plane that faces the surgeon, permitting excellent visualization of the valve and subvalvular structures. Several maneuvers are helpful in achieving optimal exposure. After median sternotomy, the pericardium is
Comment
The results of mitral valve operations depend on patient selection and the surgical procedure. Fundamental to a flawless surgical procedure is excellent and consistent exposure of the mitral valve. Although several techniques to improve mitral valve exposure have evolved, these approaches may, in fact, make the procedure more complex. The exposure obtained using the described techniques has facilitated the performance of all types of mitral valve procedures. Although it is important for
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Cited by (9)
The Mitral Hooks: Visualization of Mitral Valve Made Easy
2007, Annals of Thoracic SurgeryCitation Excerpt :The correct approach and good exposure plays a key role in the success of any surgical procedure, particularly in mitral valve surgery. The exposure is less than ideal for many surgeons in the presence of the small left atrium, pulmonary hypertension, biventricular hypertrophy, the deeply located left atrium, counterclockwise rotations of the heart, and severe rheumatic mitral pathology [3, 5], despite the availability of various modifications [2, 4] and techniques to improve visualization of the mitral valve to the extent of cardiac autotransplantation [1, 5]. In a mailed questionnaire to more than 3,000 cardiothoracic surgeons, Novitzky and colleagues [1] reported inadequate mitral valve exposure being experienced by 70% of surgeons and more than 50% extended the atrial incision either vertically or horizontally, some of them almost abandoning the procedure for lack of exposure.
Use of untreated pericardial patches for atrial septal defect closure [2]
2000, Annals of Thoracic SurgeryExposure of the mitral valve by transecting the ascending aorta during aortic and mitral valve replacement
2000, Annals of Thoracic SurgeryPredictability and durability of mitral valve repair in patients with severe degenerative mitral regurgitation in medium sized centres
2023, Annals of the Royal College of Surgeons of EnglandSurgical approaches to the mitral valve: variable paths to the same destination
2018, Indian Journal of Thoracic and Cardiovascular SurgeryMitral valve prolapse: Role of 3D echocardiography in diagnosis
2012, Current Opinion in Cardiology