Complete and optimal visualization of the mitral apparatus is a prerequisite for accurate repair or replacement of the mitral valve. A vertical left atriotomy in just posterior to the interatrial groove is the most commonly used approach.
However,
exposure can be difficult under under certain circumstances, such as small left atrium or reoperation. Other approaches have been advocated to deaf with this difficult situations. We used an extended transseptal approach in 10 patients. Good
clinical
results and excellent educational effects were obtained.
The extended transseptal approach combines two semicircular atrial incisions circumseribing 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. Right atrial and septal incisions are joined at the superior end of the interatrial septum and extended across the
dome
of
the left atrium to the left atrial appendage.
The mitral valve was replaced in all 10 patients. Four of 10 patents had other simultaneous valve procedure: one had aortic valve replacement: 2 underwent tricuspid annuloplsty:1 had aortic valve replacement and tricuspid annuloplasty. There was
no
hospital death complication. Among the 5 patients who had atrial fibrillation preoperatively, 4 had atrial fibrillation postoperatively, and 1 converted to sinus rhythm, the five patients who were in normal sinus rhythm preoperatively remained in
sinus
rhythm after replacement.
A review of our results with this approach confirms the efficacy and safty of this method. So we recommand this approach for routine mitral valve procedure, especially difficult situations, such as a small left atrium or the redo operation.
(Korean
J
Thoracic Cardiovas Surg 1993;26:909-14)
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