Improved combined superior-transseptal approach to the mitral valve.
In mitral valve surgery, the combined superior-transseptal approach gives excellent exposure of the mitral valve, but it is lengthy and complex. A modified version of this approach was made without cutting the right atrial appendage and the dome of the right atrium. This shorter procedure was evaluated in 30 patients aged 4-61 years undergoing complex mitral valve operations including mitral repair (33.3%), reoperation (30%), and small left atrium (30%). The mitral valve was exposed well in all cases. Because of the shorter incision, closure was relatively easy. The aortic crossclamp time was 117 +/- 29.9 min (range, 53-173). There were no major complications. Cardiac rhythm resumed spontaneously after release of the aortic clamp in 93.3% of patients, including 36.7% who regained sinus rhythm from arrhythmia preoperatively. There was no heart block, bleeding, or mortality. Results at 3 months were good. Despite a decreased operative field, this modified approach provided adequate exposure for all the required techniques. The benefits of this approach are a shorter incision in the atrial muscle, and simplified closure technique.
Nguyen
Huu Uoc
HU
Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam. uocdhyhn101@yahoo.com.vn
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003250:Constriction; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult