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An alternate approach to valve replacement in patients with mitral stenosis and severely calcified annulus  Sameh M. Said, MD, Hartzell V. Schaff, MD 

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Presentation on theme: "An alternate approach to valve replacement in patients with mitral stenosis and severely calcified annulus  Sameh M. Said, MD, Hartzell V. Schaff, MD "— Presentation transcript:

1 An alternate approach to valve replacement in patients with mitral stenosis and severely calcified annulus  Sameh M. Said, MD, Hartzell V. Schaff, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 147, Issue 6, Pages e76-e78 (June 2014) DOI: /j.jtcvs Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 A, Preoperative transthoracic echocardiogram showing prominent calcification of the mitral annulus and intervalvular fibrosa (white arrows). LV, Left ventricle; LA, left atrium. The Journal of Thoracic and Cardiovascular Surgery  , e76-e78DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 A, The conduit was placed between the left atrial appendage and left ventricular apex. B, The long limb of the valved conduit was excised, and the graft was excised down to approximately 2 cm above the valve. Next, the valve was turned upside down before it was sewn to the ventricle. C, The long limb of the graft was sewn to the amputated left atrial appendage. D, An apical left ventriculotomy was made, and the remaining portion of the conduit was beveled and sewn to the left ventricular apex using multiple interrupted 3-0 Prolene sutures. E, The 2 portions of the valved conduit were then sewn together to complete the left atrial-to-left ventricular bypass. The Journal of Thoracic and Cardiovascular Surgery  , e76-e78DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Intraoperative photographs showing the completed left atrial appendage to left ventricular bypass. A, The left ventricular apex has been lifted to show the location of the distal anastomosis. Note that the conduit valve has been positioned as close to the apex as possible. B and C, The conduit was located along the left side of the heart, representing the shortest possible distance from the left atrium to the left ventricle. D, The proximal anastomosis where the long graft of the conduit was connected to the left atrial appendage. The Journal of Thoracic and Cardiovascular Surgery  , e76-e78DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

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