Surgical Approaches to the Mitral Valve

Balasundaram, S.; Durán, Carlos M.G.

doi:10.1111/j.1540-8191.1990.tb01033.x

Cited by 25 publications

(7 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Adequate exposure of the mitral valve is a critical factor of success for both replacement and repair. There are various approaches to expose the mitral valve apparatus, including the classic vertical interatrial groove approach, the transseptal approach, and the left atrium roof approach [Dubost 1966;Brawley 1980;Balasundaram 1990;Nienaber 2006].…”

Section: Introductionmentioning

confidence: 99%

Extended Vertical Transseptal Approach versus Transseptal Approach for Mitral Valve Operation

Wang¹,

Wu²,

Wei³

et al. 2014

HSF

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Extended Vertical Transseptal Approach versus Transseptal Approach for Mitral Valve Operation

Wang¹,

Wu²,

Wei³

et al. 2014

HSF

View full text Add to dashboard Cite

show abstract

“…13 Hence, in view of the excellent long-term results of repair in MVD 22 and the absence of residual MR, restoration of normal annular saddle shape and dynamics may not be essential for durable repair in MVD. 23 Leaflet stress depends on multiple factors, 24 and preventing further saddle-shape loss while suppressing billowing may effectively reduce leaflet stress after repair. 7 To improve repair procedures (surgical or percutaneous), 3D mitral characteristics before and after repair and their link to the repair outcome, ie, the recurrence of MR, should be established in future studies.…”

Section: Grewal Et Al 3d-echo Mitral Annulusmentioning

confidence: 99%

Mitral Annular Dynamics in Myxomatous Valve Disease

et al. 2010

View full text Add to dashboard Cite

Background-Mitral annulus is a complex structure of poorly understood physiology. Full-volume real-time 3-dimensional transesophageal echocardiography offers a unique opportunity to completely image and quantify mitral annulus size and motion. Methods and Results-Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 32 patients with myxomatous valve disease (MVD) and moderate to severe regurgitation, 15 normal control subjects, and 10 patients with ischemic mitral regurgitation of identical body surface area. Mitral annular dimensions (circumference, area, anteroposterior and intercommissural diameters, height, and ratio of height to intercommissural diameter ratio, which appraises annular saddle-shape depth) were measured throughout the cardiac cycle with dedicated quantification software. Compared with direct surgical measurement, 3-dimensional anterior annular dimension provided reliable measurements (mean difference, 0.1Ϯ0.1 mm; Pϭ0.73; 95% confidence interval, Ϯ4.4 mm). Annular dimensions were larger in MVD patients compared with control subjects in diastole (all PϽ0.05). Normal annulus displayed early-systolic anteroposterior (PϽ0.001) and area (Pϭ0.04) contraction, increased height (PϽ0.001), and deeper saddle shape (ratio of height to intercommissural diameter, 15Ϯ1% to 21Ϯ1%; PϽ0.001), whereas intercommissural diameter was unchanged (Pϭ0.30). In contrast, MVD showed early-systolic intercommissural dilatation (Pϭ0.02) and no area contraction (Pϭ0.99), height increase (Pϭ0.11), or saddle-shape deepening (Pϭ0.35). Late-systolic MVD annular saddle shape deepened but annular area excessively enlarged (PϽ0.04) as a result of persistent intercommissural widening (PϽ0.02). MVD annulus also contrasts with ischemic mitral regurgitation annulus, which, despite similar anteroposterior enlargement, is narrower and essentially adynamic. After MVD repair, the annulus remained dynamic without systolic saddle-shape accentuation (Pϭ0.30). Conclusions-Real-time 3-dimensional transesophageal echocardiography provides insights into normal, dynamic mitral annulus function with early-systolic area contraction and saddle-shape deepening contributing to mitral competency. MVD annulus is also dynamic but considerably different with loss of early-systolic area contraction and saddle-shape deepening despite similar magnitude of ventricular contraction, suggestive of ventricular-annular decoupling. Subsequent area enlargement may contribute to mitral incompetence. After mitral repair, MVD annulus remains dynamic without systolic saddle-shape accentuation. Thus, real-time 3-dimensional transesophageal echocardiography provides new insights that allow the refining of mitral pathophysiology concepts and repair strategies. (Circulation.

show abstract

“…Various approaches to the mitral valve have been described 1,2 . These include the classical LA approach, transseptal incision, extended transseptal incision up to the roof of the LA, the Guiraudon incision, 3 the biatrial inferior transseptal approach (Dubost), transaortic, the left atrial appendage approach, through the LV, and autotransplantation after explantation of the heart through cuff of the atria.…”

Section: Discussionmentioning

confidence: 99%

The Transseptal T-Cut-What More Can We See?

Dhaliwal¹,

Luthra²,

Uppluri³

2008

Journal of Cardiac Surgery

View full text Add to dashboard Cite

An optimal approach to the mitral valve for repair or replacement must provide adequate exposure even in a small left atrial and redo cases, without need for forceful retraction. This benefit of good exposure must not be at the cost of increased morbidity from increased postoperative bleeding, SA node, or atrioventricular node dysfunction. We describe a simple technique of transseptal T-cut for exposure of the mitral valve, which is without the attendant complications of the other techniques.

show abstract

Surgical Approaches to the Mitral Valve

Cited by 25 publications

References 14 publications

Extended Vertical Transseptal Approach versus Transseptal Approach for Mitral Valve Operation

Extended Vertical Transseptal Approach versus Transseptal Approach for Mitral Valve Operation

Mitral Annular Dynamics in Myxomatous Valve Disease

The Transseptal T-Cut-What More Can We See?

Contact Info

Product

Resources

About