Guiraudon G M, Ofiesh J G, Kaushik R
Department of Surgery, University Hospital, University of Western Ontario, London, Canada.
Ann Thorac Surg. 1991 Nov;52(5):1058-60; discussion 1060-2. doi: 10.1016/0003-4975(91)91281-y.
Optimal mitral valve operation requires adequate exposure without impairment of atrial physiology, namely sinus node and atrioventricular node function. We used an extended vertical transseptal atrial approach in 34 consecutive patients. The extended vertical transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly, allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. The right atriotomy is extended superiorly in the right coronary fossa between the right atrial appendage and the atrioventricular sulcus to meet the septal incision. The two joint incisions are extended onto the left atrial roof transversely. At this point, the two semicircular incisions are performed and joined, and mitral valve operation is performed. There were 18 women and 16 men. Five patients had ischemic mitral valve regurgitation, 18 had mitral valve prolapse, and 11 had rheumatic heart disease. The mitral valve was replaced in 17 patients and repaired in 17. There were no perioperative complications associated with the atriotomies, ie, no bleeding, no atrioventricular nodal dysfunction, and no sinus node dysfunction. The extended vertical transatrial septal approach provides good mitral valve exposure without inherent complications.
最佳的二尖瓣手术需要充分暴露，同时不损害心房生理功能，即窦房结和房室结功能。我们对34例连续患者采用了改良垂直经房间隔入路。改良垂直经房间隔入路结合了两个半圆形心房切口，分别在前上方环绕三尖瓣和二尖瓣环，通过使用牵引缝线使心室侧移位来暴露二尖瓣。右心房沿房室沟在前部切开。房间隔经卵圆窝垂直切开。右心房切口在右冠状动脉窝内向上延伸，位于右心耳和房室沟之间，与房间隔切口会合。两个联合切口横向延伸至左心房顶部。此时，进行两个半圆形切口并连接起来，然后进行二尖瓣手术。患者中女性18例，男性16例。5例患者为缺血性二尖瓣反流，18例为二尖瓣脱垂，11例为风湿性心脏病。17例患者进行了二尖瓣置换，17例进行了二尖瓣修复。没有与心房切开相关的围手术期并发症，即没有出血、没有房室结功能障碍，也没有窦房结功能障碍。改良垂直经房间隔入路能提供良好的二尖瓣暴露，且无内在并发症。
