title: Modified Valsalva Maneuver for Venous Cannulation in Cardiopulmonary Bypass for Minimal Incision Mitral Valve Surgery.
abstract: A 69-year-old man underwent minimal incision mitral valve repair for severe symptomatic mitral regurgitation. The echocardiography showed that he had normal left ventricular function with a moderately to severely dilated left atrium, a mildly dilated right atrium, and a large patent foramen ovale. The multistage venous cannulation was very challenging because we could not negotiate the guide wire from the inferior vena cava via the right atrium into the superior vena cava. Despite several attempts, the guide wire would pass into the patent foramen ovale. Methods that we routinely attempt with difficult cannulations such as withdrawing and reinserting, twisting, and to-and-fro movements did not result in success. Eventually, we attempted a novel maneuver, the modified "Valsalva maneuver," that worked incredibly well.
authors.affiliation: From the Departments of *Cardiothoracic Surgery and †Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia; and ‡School of Medicine Fremantle, The University of Notre Dame Australia and The Baird Institute, Newtown, New South Wales, Australia.
authors.forename: Kawryshanker
authors.initials: K
authors.lastname: Rajaratnam
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Tak
authors.forename: Sweeka
authors.initials: S
authors.lastname: Alexander
authors.forename: Jurgen
authors.initials: J
authors.lastname: Passage
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D016896:Treatment Outcome; D014636:Valsalva Maneuver