SURGICAL ANATOMY

SURGICAL APPROACH

PATHOLOGY

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SURGICAL APPROACH

MITRAL VALVE

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• Several surgical approaches exits, the choice of which depends on the given clinical situation.
• Left Thoracotomy through the fourth intercostal space was used for closed mitral commisurolysis and commissurotomies.
• Short Right Thoracotomy is preferred for minimally invasive mitral surgery
• Right-sided anterolateral thoracotomy is preferred in redo mitral surgery
• Right- or left-sided thoracotomy 

              - May also be used redo operations where LIMA has been used as a graft for coronary 
                 revascularization procedure.
              - This is best performed without aortic cross clamping on a beating heart.
              - This avoids the risk of right ventricular injury in re sternotomies.
              - Avoids the need to dissect a patent LIMA graft
              - Maintains normal coronary perfusion.
              - Aortic incompetence has to be ruled out beforehand.

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Approach to the mitral valve via longitudinal left atriotomy
​(through the dissected interatrial groove in a Sondergaard’s plane)

Transseptal approach to the mitral valve
​(through the right atrium and the interatrial septum)