A method for improved exposure of the mitral valve: Cannulation of innominate vein and division of superior vena cava for extended left atriotomy in mitral valve operations

Mitral annuloplasty with the interatrial groove-left atrial dome approach in a patient with Marfan syndrome

“…This method can effectively increase exposure of the operative field and improve the surgical results, without complications such as arrhythmia or conduction block after the operation. Some authors believe that for patients with a small LA, division of the SVC for extended left atriotomy in MV operations is a viable approach [ 4 , 5 ].…”

Repair of aortic arch coarctation and innominate artery aneurysm with branched Dacron graft

“…Although narrowing of the aortic arch is not infrequently seen in the setting of congenital heart surgery, aortic coarctations that persist into adult life are unusual, and those that originate between the arch vessels are very rare, constituting approximately 1% of all coarctation cases. [4][5][6][7][8] Although aortic coarctation often occurs as an isolated malformation, it is also associated with a bicuspid valve in up to 85% of patients and also with other associated anomalies, including left heart obstructive lesions, congenital abnormalities of Brief Communications the mitral valve, ventricular septal defects, and patent ductus arteriosus. The pathogenesis of the stenosis is not well understood but seems to involve at least 2 mechanisms.…”

“…Therefore the superior vena cava was transected just cephalad to the sinoatrial node, and the atriotomy was extended across the dome of the left atrium posterior to the aorta and pulmonary artery. [6][7][8] Excellent exposure of the mitral valve resulted, and careful examination revealed a morphologically normal valve and chordal apparatus. It was believed at this point that the mitral insufficiency was most likely caused by annular dilatation, and a 26-mm Cosgrove-Edwards annuloplasty band (model 4600; Edwards Lifesciences, Irvine, Calif) was placed without difficulty.…”