Surgical Approach to Left Ventricular Inflow Obstruction Due to Dilated Coronary Sinus Florentino J. Vargas, MD, Jorge Rozenbaum, MD, Ricardo Lopez, MD,

Slides:

Advertisements

Similar presentations

Ricardo L. Oliveira, MD, Moishe Liberman, MD, PhD

Advertisements

Reentrant and Focal Activations During Atrial Fibrillation in Patients With Atrial Septal Defect Takashi Nitta, MD, PhD, Shun-ichiro Sakamoto, MD, PhD,

The “Broken Ring” Sign in Magnetic Resonance Imaging of Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava PAUL R. JULSRUD, M.D.,

Autotransplantation for Threatened Cardiac Rupture After Left Ventricular Repair Hiroaki Hata, MD, PhD, Motomi Shiono, MD, PhD, Mitsuru Iida, MD, PhD,

Sinus Venosus Atrial Septal Defect: Repair with an Intra-Superior Vena Cava Baffle Brian W. Duncan, MD Operative Techniques in Thoracic and Cardiovascular.

Repair of Unusual Types of Total Anomalous Pulmonary Veins

Atrial switch operation: past, present, and future

Interim Results of the 5-Box Thoracoscopic Maze Procedure

Late Occurrence of Atrial Arrhythmias After the Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Surgery Taijiro Sueda, MD,

A technique for repair of partial anomalous pulmonary vein connection to the superior vena cava José Pedro da Silva, MD, Luciana da Fonseca da Silva,

Evolving Surgical Strategy for Sinus Venosus Atrial Septal Defect: Effect on Sinus Node Function and Late Venous Obstruction Robert D. Stewart, MD, Frédérique.

Anaesthetic implications of grown-up congenital heart disease

Supra-Annular Mitral Valve Replacement in Children

Modified Starnes Procedure in a Neonate With Severe Tricuspid Regurgitation Ashok Muralidaran, MD, Richard W. Kim, MD, Gary S. Kopf, MD, Nicholas P. Pietris,

Late Assessment After Biventricular Repair for Isomerism Heart

Complete Atrioventricular Canal: Comparison of Modified Single-Patch Technique With Two-Patch Technique Carl L. Backer, MD, Robert D. Stewart, MD, Frédérique.

Apical ventricular septal defects: follow-up concerning anatomic and surgical considerations Stella Van Praagh, MD, John E Mayer, MD, Norman B Berman,

Gianluigi Bisleri, MD, Claudio Muneretto, MD

Neonatal Repair of Truncus Arteriosus With “Scimitar-Like” Mixed Total Pulmonary Venous Return Giovanni Battista Luciani, MD, Stiljan Hoxha, MD, Gianluca.

Novel Repair for Obstructed Total Anomalous Pulmonary Venous Connection to Coronary Sinus Sajan Koshy, MCh, Raman Krishna Kumar, DM, Rao Suresh Gururaja,

Circular shunt in bidirectional cavopulmonary anastomosis

Gananjay G. Salve, MCh, Shreepal A. Jain, MD, Bharat V

Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava—The Warden Procedure Robert A. Gustafson,

Dennis M. Mello, MD, John Fahey, MD, Gary S. Kopf, MD

Norwood Procedure Combined With the Starnes Procedure

Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus Daniel J DiBardino, MD, Charles D Fraser,

Gananjay G. Salve, MCh, Shreepal A. Jain, MD, Bhavesh M

Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure

Intra-atrial rerouting by the posterior left atrial wall flap for total anomalous pulmonary venous return drainage into the coronary sinus in neonates

Ricardo L. Oliveira, MD, Moishe Liberman, MD, PhD

Efficacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery Taijiro Sueda, MD, Katsuhiko Imai,

In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries Ali Dodge-Khatami, MD, PhD, Alexander Kadner,

Joseph A. Dearani, MD, Sameh M. Said, MD, Harold M

The Ross Procedure: New Insights Into the Surgical Anatomy

Atrial Switch Operation in a Patient With Dextrocardia, Bilateral Superior Vena Cavae, Left Atrial Isomerism and Unroofed Coronary Sinus Sachin Talwar,

Christopher J. Knott-Craig, MD, Steven P. Goldberg, MD, Edward D

Successful surgical treatment of hypoplastic left heart syndrome associated with a divided left atrium that was diagnosed intraoperatively Yuji Naito,

Intra-Atrial Rerouting and Maze Procedure for an Adult Patient in Cor Triatriatum, Persistent Left Superior Vena Cava, and Atrial Fibrillation Koichi.

Concealed Left Ventricle to Right Atrium Fistula Complicating Infective Endocarditis Tatsushi Onzuka, MD, PhD, Shoji Morishige, MD, Yoshiyuki Yamashita,

Hemoptysis as a rare presentation of cor triatriatum sinister

Double-outlet right ventricle with complete atrioventricular canal

Transcatheter Mustard Revision Using Endovascular Graft Prostheses

Prophylactic Atrial Arrhythmia Surgical Procedures With Congenital Heart Operations: Review and Recommendations Constantine Mavroudis, MD, John M. Stulak,

Monobloc aorto-mitral homograft as a treatment of complex cases of endocarditis Jean-François Obadia, MD, PhDa, Olivier Raisky, MDa, Laurent Sebbag, MDa,

Efficient Removal of Retained Intracardiac Air Utilizing Buoyancy

A novel atrial volume reduction technique to enhance the Cox maze procedure: Initial results Akira Marui, MD, PhD, Takeshi Nishina, MD, PhD, Keiichi.

Aorto-Left Ventricular Tunnel: An Alternative Surgical Approach

The Neonatal Arterial Switch Operation: How I Teach It

Successful Use of Transvenous Atrial and Bifocal Left Ventricular Pacing in Ebstein’s Anomaly After Tricuspid Prosthetic Valve Surgery J. Alberto Lopez,

Systemic Venous Rerouting Through the Coronary Sinus for ccTGA With Bilateral SVCs Satoshi Asada, MD, Masaaki Yamagishi, MD, PhD, Takako Miyazaki, MD,

Aortic Translocation for the Management of Double-Outlet Right Ventricle and Pulmonary Stenosis With Dextrocardia: Technique to Avoid Coronary Insufficiency

Tricuspid Valve Repair: How I Teach It

Double-Root Translocation for Double-Outlet Right Ventricle With Noncommitted Ventricular Septal Defect or Double-Outlet Right Ventricle With Subpulmonary.

Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy Giovanni Stellin, MD, Massimo Padalino, MD,

Repair of Partial Atrioventricular Septal Defect: Age and Outcomes

Late results of palliative atrial switch for transposition, ventricular septal defect, and pulmonary vascular obstructive disease Harold M Burkhart,

Nikaidoh Procedure: How I Teach It

Management of Catheter-Related injuries to the coronary sinus

Norwood Stage 1 With Surgical Ventricular Reconstruction and Mitral Valve Repair for Neonatal Idiopathic Left Ventricular Dilated Cardiomyopathy Patrick.

Modified Cabrol Shunt to Treat Left Ventricular Rupture

Localized Pericardial Hematoma Presenting With Acute Hypoxemia

Hypoplastic Left Heart Syndrome With Anomalous Origin of the Right Coronary Artery Julie Cleuziou, MD, Felix Haas, MD, Christian Schreiber, MD, Hans-Jörg.

Neo-Left Atrium Construction on the Beating Heart After Extirpation of a Huge Mediastinal Tumor Invading Heart and Lung Miralem Pasic, MD, PhD, Evgenij.

Perforation of a Tricuspid Pouch Caused by Infective Endocarditis

Transcaval Correction of Partial Anomalous Pulmonary Venous Drainage Into the Superior Vena Cava Mohamed Nassar, MD, Virginie Fouilloux, MD, Loïc Macé,

Performing the Left Atrial Maze Ablation Pattern Without Atriotomy

Shaun P. Setty, MD, John L. Bass, MD, K. P

Right ventricle-sparing heart transplant: promising new technique for recipients with pulmonary hypertension John A Elefteriades, MD, Costantinos J Lovoulos,

Divided Left Atrium (Cor Triatriatum) in the Setting of Common Atrium

Ablation of Atrial Fibrillation With Minimally Invasive Mitral Surgery

Presentation transcript:

Surgical Approach to Left Ventricular Inflow Obstruction Due to Dilated Coronary Sinus Florentino J. Vargas, MD, Jorge Rozenbaum, MD, Ricardo Lopez, MD, Miguel Granja, MD, Ana De Dios, MD, Beatriz Zarlenga, MD, Enrique Flores, MD, Enrique Fischman, MD, Eduardo Kreutzer, MD The Annals of Thoracic Surgery Volume 82, Issue 1, Pages 191-196 (July 2006) DOI: 10.1016/j.athoracsur.2006.02.062 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative echocardiogram. (A) Apical four-chamber view (systole). The interatrial septum bulges toward the right atrium in its superior portion, and toward the left atrium in the inferior part (arrows) adopting an S-shaped configuration. (B) Apical four-chamber view (diastole). The dilated coronary sinus is occupying a major part of the external border of the left atrium and protrudes, causing obstruction to the left atrial emptying at a supravalvular mitral level (arrow). Both the mitral valve and left ventricle are smaller than the tricuspid valve (mitral valve /tricuspid valve annulus ratio: 0.6 cm) and the right ventricular chamber. (CS = coronary sinus; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2006 82, 191-196DOI: (10.1016/j.athoracsur.2006.02.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative angiogram performed in the inferior vena cava displays interruption of the inferior vena cava, with hemiazygous continuation to left superior vena cava and to a dilated coronary sinus. Washout from the left superior vena cava is observed at the hemiazygous-left superior vena cava junction level. (AZ = interrupted inferior vena cava-hemiazygous continuation; CS = coronary sinus; LSVC = left superior vena cava.) The Annals of Thoracic Surgery 2006 82, 191-196DOI: (10.1016/j.athoracsur.2006.02.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Surgical technique. (A) Interrupted inferior vena cava-hemiazygous continuation to left superior vena cava (dotted line) and to the dilated coronary sinus. The innominate vein is absent. The dilated coronary sinus causes left ventricular inflow obstruction. The mitral valve is hidden underneath the dilated coronary sinus. (B) Through a wide excision of the atrial septum, the wall of the coronary sinus was entirely removed (arrow) from inside the left atrium. (C) The previously enlarged atrial septal defect is closed with a pericardial patch. (D) The left superior vena cava together with a wide circular cuff of left atrial wall is separated from the left atrium. A large orifice was created in the roof of the left atrium. The left atrial appendage will be opened longitudinally following the dotted line (arrow) to create a flap. The pulmonary artery is retracted. (E) A wide flap was tailored with the opened left atrial appendage and used to close the large defect created in the roof of the left atrium. (F) The tip of the right atrial appendage is widely opened, its inner surface liberated from residual muscular trabeculae to create an unobstructed tubular structure, and a large anastomosis is performed with the wide circular cuff of left atrial tissue previously isolated together with the left superior vena cava, thereby establishing left superior vena cava-right atrium continuity. The right atriotomy was closed. (Ao = aorta; azg = hemiazygous [interrupted inferior vena cava-hemiazygous continuation to left superior vena cava]; cs = coronary sinus; laa = left atrial appendage; laf = left atrial flap; lsvc = left superior vena cava; m = mitral valve; p = atrial septal patch; pa = pulmonary artery; raa = right atrial appendage; rsvc = right superior vena cava.) The Annals of Thoracic Surgery 2006 82, 191-196DOI: (10.1016/j.athoracsur.2006.02.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative catheterization. (A) Anteroposterior. (B) Lateral. The cavogram performed in the interrupted inferior vena cava displayed the systemic venous return as it enters into the right atrium following its way from the interrupted inferior vena cava through the hemiazygous vein-left superior vena cava to right atrial appendage anastomosis. A widely patent left superior vena cava-right atrial appendage anastomosis was demonstrated. Washout from the upper left superior vena cava is present. (AZ = interrupted inferior vena cava-hemiazygous continuation; LSVC = left superior vena cava; RA = right atrium; RAA = right atrial appendage.) The Annals of Thoracic Surgery 2006 82, 191-196DOI: (10.1016/j.athoracsur.2006.02.062) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions