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Supra-Annular Mitral Valve Replacement in Children Kirk R. Kanter, MD, Brian E. Kogon, MD, Paul M. Kirshbom, MD The Annals of Thoracic Surgery Volume 92, Issue 6, Pages (December 2011) DOI: /j.athoracsur Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
Fig 1 (A)Operative technique. For patients without an atrioventricular septal defect, a standard left atrial incision is performed anterior and parallel to the right pulmonary veins. This can be extended onto the dome of the left atrium behind the superior vena cava. (B) The native mitral valve is excised entirely including the chordae and tips of the papillary muscles. Often, an additional separate right atrial incision is helpful to allow placement of right atrial-based valve sutures. The left atrial appendage is used as a landmark; it always is on the low pressure side of the left atrium. The distance between the pledgeted sutures and the native mitral annulus is minimized both to reduce the volume of “ventricularized” left atrium and to avoid compression of the pulmonary veins from the prosthesis. (C) Typically, for the anterior third of the sewing ring, the sutures are placed through the atrial septum with the pledget on the right atrial side avoiding the atrioventricular node. The valve is rotated with the prosthetic valve leaflets in an anti-anatomic orientation. The excursion of the valve leaflets is carefully checked and the valve rotated as necessary to minimize impingement of subvalvular tissue on the valve leaflets. (Ao = aorta; CS = coronary sinus; IVC = inferior vena cava; LA = left atrium; LAA = left atrial appendage; MV = mitral valve; SVC = superior vena cava). The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
Fig 2 Kaplan-Meier actuarial freedom from any reoperation for the 14 operative survivors after first supra-annular MVR. (SA-MVR = supra-annular mitral valve replacement.) The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
Fig 3 Kaplan-Meier actuarial freedom from death after first supra-annular MVR. (SA-MVR = supra-annular mitral valve replacement.) The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
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