Techniques of open mitral valvotomy , Biology

Assignment Help:

Open Mitral Valvotomy :  Technique: A median stemotomy is done; peri cardium opened and stay sutures taken. After heparinisation ascending aorta is cannulated and then SVC and IVC cannulae inserted. If the left atrium is small, tapes arc passed around SVC and NC cannulae for Lola1 cardio pulmonary bypass. Cardioplegia cannulae arc inserted into the ascending aorta and coronary sinus. The inter atrial groove is developed. Dissection to separated RA from LA gives better exposure to the mitral valve in case the left atrium is very small. By dissecting under SVC and IVC more of left atrium will be available for atriotomy. Left atrium could also be approached through right abiotorny and incising the septum (trans septa! approac11) or through the roof of left atrium between ascending aorta and superior vena cava (superior approach).

Aorta is clamped, left atrium opened and cardioplegia is given. Left atrium is widely opened and a Cooley atrial retractor or the self-retaining atrial retractor is applied. The valve is inspected for calcification and mobility. Stay sutures using 40' prolene are taken on the anterior and posterior cusp margins. By traction on the sutures the anterolateral and postern medial commissures are

 identified. Stab incisions are made on the fused commissures close to the annulus and from there extended to the central orifice of the valve. The incision must be along the true commissure. Traction on the commissms using blunt hooks will help in identifying the chordae and papillary muscles. The fused chordae are separated by sharp dissection after identifying the ones going to

 either of the leaflets. It may require incision into the papillary muscles and at times fenestration of the fused chordae, the essential principle is to get a mobile valve.

Decalcification of the leaflets will be required in some cases. The valve competence is kited by injecting saline into the LV. LRCt atrial incision is closed and complete de-airing of the left side of the heart is done. Aortic clamp is removed and de-airing through the aortic root needle is continued till heart ejects well and good blood pressure is achieved. Trans oesophageal echo is done to make sure the valvotomy is adequate and mitral regurgitation is less than mild. The assessnlent of MR should be when blood pressure is good. Open valvotomy is the procedure of choice when patient is in AF and left atrium has clots. The clots are removed; left atrium is washed and sucked thoroughly. Left atrial appendage is obliterated by tying it off from outside or by sutuiing from inside using prolene sutures. If the atrial fibrillation has been present for more than one year or left atrium is larger than 50mrns, it is better to combine a COX 111 (Maze) procedure to reduce the chances of post-operative atrial fibrillation.


Related Discussions:- Techniques of open mitral valvotomy

Artificial respiration, Artificial respiration First - aid for drown...

Artificial respiration First - aid for drowning victims should aim to restore respiration as quickly as possible. First of all, nose, mouth and throat of the victim shoul

Merits of micro propagation, Merits of Micro Propagation The special m...

Merits of Micro Propagation The special merits of micro propagation are: 1. It considerably increases the rate of multiplication 2. High rate of multiplication can be ma

What is the minimal space between implants and implant, Minimal space betwe...

Minimal space between implants and implant and adjacent tooth It is important to maintain a distance of at least 1.5 to 2 mm between an implant and adjacent tooth and a distanc

What is osmosis, What is Osmosis ? Osmosis :  Osmosis refers to the...

What is Osmosis ? Osmosis :  Osmosis refers to the diffusion of water across a semi-permeable membrane from an area of higher concentration of water to an area of lower con

Pathogenesis, Even though association between GAS pharyngitis and the ARF i...

Even though association between GAS pharyngitis and the ARF is fairly well established, the exact pathogenic mechanisms are not clearly understood. However, two mechanisms are post

Littoral zone, Littoral Zone Plants of the littoral zone Two types ...

Littoral Zone Plants of the littoral zone Two types of plants occur here: Non-rooted phytoplanktons which include all kinds of algae occurring in the limnetic as wel

Fragmentation - types of asexual reproduction, Fragmentation - Types of Ase...

Fragmentation - Types of Asexual Reproduction Fragmentation is a phenomenon where parent animal spontaneously (on its own accord) splits into two or more fragments. Each one o

Brain region responsible for the equilibrium of the body, Q. Which is the b...

Q. Which is the brain region responsible for the coordination and equilibrium of the body? In the central nervous system the cerebellum is the main controller of the motor equi

Zoology, adaptation and distribution of synaptura (flat fish)

adaptation and distribution of synaptura (flat fish)

Explain about the demand curve or schedule in short, Explain about the Dema...

Explain about the Demand curve or schedule in short. The demand curve or demand schedule shows the total quantity purchased through all buyers, within aggregate, into the marke

Write Your Message!

Captcha
Free Assignment Quote

Assured A++ Grade

Get guaranteed satisfaction & time on delivery in every assignment order you paid with us! We ensure premium quality solution document along with free turntin report!

All rights reserved! Copyrights ©2019-2020 ExpertsMind IT Educational Pvt Ltd