Besides annular dilatation, the mitral valve annulus can be severely affected by other specific pathological processes, such as extensive calcification or abscesses. In rare circumstances, the annulus may present either a post-traumatic or an idiopathic pseudoaneurysm. These lesions are frequently…
In the early years of valve surgery, annular dilatation was considered the primary cause of mitral valve regurgitation. With the exception of McGoon's techniques of posterior leaflet plication, the usual repair techniques involved pledgetted sutures placed at the commissures or…
MITRAL VALVE EXPOSURE After extracorporeal circulation has been instituted, adequate exposure of the mitral valve is mandatory to perform a safe and effective operation. Pericardial adhesions, if present, are released up to the apex. The interatrial approach is used in…
Since Général Baron Nicolas Corvisart, Napoléon's physician, recognized that heart failure may be due to mitral valve regurgitation following chordae rupture, multiple studies have emphasized the extreme complexity of the pathophysiology of the mitral valve. The pathophysiological triad and functional…
The anatomy of heart valves is usually described with respect to transverse or longitudinal sections of the heart, which provide optimal viewpoints of the heart's different structures ( Fig. 5-1 ). These anatomical views have limited practical value to surgeons…
In the operating room, standard monitoring techniques (e.g., central venous line, arterial line, bladder catheter) are used. Swan-Ganz catheter monitoring is useful in high-risk patients with elevated pulmonary pressure or depressed ventricular function. An external defibrillator is placed in mini-invasive…
Sound perioperative management of the patient undergoing a valve operation requires careful attention to details to ensure an optimal outcome. PREOPERATIVE INVESTIGATIONS All patients undergoing valvular surgery should have a complete workup including clinical examination, chest x-ray, transthoracic echocardiography, and…
During the cardiac cycle the heart's four valves ( Fig. 2-1 ) channel blood flow in a single direction: from the atria to the ventricles and from the ventricles to the aorta and pulmonary artery. The numerous diseases that can…
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Pacemaker insertion Permanent pacing systems require the implantation of pacing electrodes in contact with the myocardium and the placement of a pulse generator in the body. There are a number of options for accomplishing these tasks. In certain circumstances it…