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The Annals of Thoracic Surgery, Vol 52, 1058-1060, Copyright © 1991 by The Society of Thoracic Surgeons
GM Guiraudon, JG Ofiesh and R Kaushik
Optimal mitral valve operation requires adequate exposure without
impairment of atrial physiology, namely sinus node and atrioventricular
node function. We used an extended vertical transseptal atrial approach in
34 consecutive patients. The extended vertical transseptal approach
combines two semicircular atrial incisions circumscribing the tricuspid and
mitral annuli anteriorly and superiorly, allowing exposure of the mitral
valve by deflecting the ventricular side using stay sutures. The right
atrium is opened anteriorly along the atrioventricular sulcus. The atrial
septum is incised vertically through the fossa ovalis. The right atriotomy
is extended superiorly in the right coronary fossa between the right atrial
appendage and the atrioventricular sulcus to meet the septal incision. The
two joint incisions are extended onto the left atrial roof transversely. At
this point, the two semicircular incisions are performed and joined, and
mitral valve operation is performed. There were 18 women and 16 men. Five
patients had ischemic mitral valve regurgitation, 18 had mitral valve
prolapse, and 11 had rheumatic heart disease. The mitral valve was replaced
in 17 patients and repaired in 17. There were no perioperative
complications associated with the atriotomies, ie, no bleeding, no
atrioventricular nodal dysfunction, and no sinus node dysfunction. The
extended vertical transatrial septal approach provides good mitral valve
exposure without inherent complications.
ARTICLES
Extended vertical transatrial septal approach to the mitral valve
Department of Surgery, University Hospital, University of Western Ontario, London, Canada.
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