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

What are the responsibilities of cber, Question 1: Explain how drug app...

Question 1: Explain how drug approval is obtained through various Regulatory Bodies in India using a flow diagram? List out the different regulatory bodies in India L

Groups of living beings that form the protist kingdom, Q. Which are the gro...

Q. Which are the groups of living beings that form the protist kingdom? The protist kingdom includes algae and protozoans. (Two groups of fungi with similar characteristics to

What are the nitrate reductase and nitrite reductase tests, Based on your u...

Based on your understanding of the nitrate reductase and nitrite reductase tests, why would the inclusion of nitrite inhibit anaerobic growth?

What is the functionality of lungs in human biology, What is the functional...

What is the functionality of Lungs in human biology? The right lung consists of three lobes, and the left lung, two lobes. Both lungs hold between 5 to 6 L of gas, called the t

Procedure for spore staining in a given bacterial culture, Explain Procedur...

Explain Procedure for Spore Staining in a Given Bacterial Culture Carry out the exercise following the steps enumerated herewith 1. Take a clean, non-greasy slide. Prepare b

What are the apical meristems, What are the apical meristems? Which kind of...

What are the apical meristems? Which kind of plant growth does this meristem promote? The Apical meristems are those primary meristems found in the apex of the stem as well as

Formation of lactate and its consumption, Formation of  lactate and  its ...

Formation of  lactate and  its consumption Formation of  lactate and  its consumption : If anaerobic conctitions prevail, the reoxidation  of NADH  through the respiratory cha

Antibodies, Antibodies Antibodies are important.tools for detecting and...

Antibodies Antibodies are important.tools for detecting and localising specific molecules in the cells due to their high specificity. The first requirement for this is to produ

Acute phase reactants, ESR and CRP are elevated in almost all patients of a...

ESR and CRP are elevated in almost all patients of arthritis and carditis and rarely in patients with chorea. ESR should be repeated periodically as it is useful in following the c

Illustrate chromosome structure, Q. Illustrate Chromosome Structure? Cy...

Q. Illustrate Chromosome Structure? Cytologists have studied chromosome morphology and have pointed out that the most interesting feature about the chromosome structure is the

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