ABSTRACT
Mitral valve replacement was performed in 21 patients using a surgical technique that preserves the entire papillary muscle and chordal apparatus. With this technique, the anterior mitral leaflet is split from the center of the free edge toward the annulus. Bilateral incisions are made from the proximal end of this split to the two mitral commissures, detaching the anterior leaflet from the annulus. These two halves of the leaflet, with all chordae intact (corresponding to the anterolateral and posteromedial papillary muscles), are judiciously trimmed to remove areas of leaflet untethered by chordae tendineae and (when necessary) fibrous thickening; then swung posteriorly and sutured to the posterior mitral annulus using mattress sutures with pledgets. This surgical technique is expected to favor the preservation of left ventricular function and avoid occurrence of irreversible left ventricular dilation/dysfunction, and has been used successfully for calcific and degenerative etiologies, using both tilting disc valves and porcine bioprostheses. It is especially useful in the implantation of tilting disc and bileaflet mechanical prostheses because anterior subvalvular chordae tissue may interfere with the disc excursion and relocated to the posterior leaflet annulus.
Subject(s)
Chordae Tendineae/surgery , Heart Valve Prosthesis , Mitral Valve/surgery , Papillary Muscles/surgery , Adolescent , Adult , Aged , Child , Female , Humans , Male , Methods , Middle Aged , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/surgery , Prosthesis Design , Suture TechniquesABSTRACT
The densely calcified ascending aorta presents a formidable challenge to the cardiac surgeon. Clamping such an aorta in the patient requiring myocardial revascularization may result in catastrophic cerebral embolism and mar an otherwise successful surgical outcome. Myocardial revascularization using ventricular fibrillation and hypothermia without aortic cross-clamping in 3 patients with severely calcified aortas is described.
