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Techniques: operation is done under general endo tracheal anaesthesia. Patient is positioned with the left chest tilted up using a sand bag under left chest. Left antero lateral thorocotomy is done through 5" intercostals space. Pericardium is opened two cm in front of phrenic nerve stay sutures are taken. Pulmonary artery pressure is assessed by palpation. A vertical mattress suture is applied above the LV apex in an avascular area. Ventricular epicardium is incised and an opening is made in the LV. It is controlled by a snare by passing the threads through it. A purse string is applied a little anterior to the base of left atrial appendage. Before applying a clamp on she left atrial appendage, it is opened momentarily to let out blood and any clot present inside the appendage. Surgeon inserts the right index finger through the left atrial appendage incision and mitral valve is palpated and assessed for size of the orifice, calcification and degree of regurgitation. The actual valvotomy is done by a Tubb's dillator inserted in a closed position, through the previously made ventriculotomy. The Tubb's dilator handle a mechanism to open the two blades to the desired amount by a screw arrangement, Before insertion, the opening is adjusted to 2.25 cms by using a scale. The dilator is then inserted into LV with left hand and guided to LA through the tight mitral orifice by the right index finger in LA. By pressing the handle with the left hand the dilator opens to desired amount and the valve opens up. The dilutor blades are positioned against the valve cusps and not the commissures. Tile dilator is removed 2nd further gradual dilatations are done by adjusting the dilator lo 2.5, 2.75, 3, 3.25 01. 3:5 cms and repeating the dilatations until the valve opens up without producing significant regurgitation. The finger is removed. Left atrial appendage and L V apical incision are sutured. Usually the pulmonary artery becomes softer. Pericardium is closed with intermpted sutures and chest closed in layers after inserting a single chest drain. If there is significant pulmonary arterial hypertension, patient is ventilated for a few hou1-s or over night.
examples of gametes
Define about the Spectral Techniques - Colorimetry? Many determinations in the biochemistry laboratory are based on measurements of radiant energy emitted, transmitted, absorbe
CHONDROITI N SULPHATE It is a linear polymer of sulphated N-acetylgalactosamine alternating with glucuronic or iduronic acid. The complex also occurs in skin, tendon and ca
What is Cytogenetics? Before the advent of modern technology, the American biologists Thomas Hunt Morgan, G.W. Beadle, H. Sturtevant, Barbara McClintock, and others contributed
Complete feed system in ruminants Complete feed system for feeding dairy animals is a departure from conventional individual rationing method. It involves the self-feeding of
List the four basic points to be kept in mind when advising food exchange. To develop the food exchange list points to keep in mind are: a) Group similar foods in one group.
plz answer me how I arrange my topic with its order ?
The nominalists deny the existence of Plato's "types". For them only individuals exist. Species are man-made artificial abstractions. But naturalists, the biologists who have actua
what is the protozoa?
Class of Mollusca - Aplacophora Worm-like, no shell, head or excretory organs mantle with chitinous cuticle or scales or spicules mantle cavity posterior. Aplacophorans are a
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