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Optimizing Mitral Valve Exposure With Conventional Left Atriotomy

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Abstract

The standard surgical approach to the mitral valve is accomplished through a longitudinal incision in the left atrium, posterior and parallel to the interatrial groove. Many other surgical approaches have evolved. This report describes a technique of optimizing mitral valve exposure via the standard approach. These modifications are simple, do not lengthen the procedure, and usually obviate the need for more complex maneuvers.

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 Surgery
    Citation 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.

  • Surgical approaches to the mitral valve: variable paths to the same destination

    2018, Indian Journal of Thoracic and Cardiovascular Surgery
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