Mitral valve replacement for inflow obstruction of left ventricular assist device in a child with restrictive cardiomyopathy Hari Tunuguntla, MD, Susan.

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Mitral valve replacement for inflow obstruction of left ventricular assist device in a child with restrictive cardiomyopathy Hari Tunuguntla, MD, Susan W. Denfield, MD, E. Dean McKenzie, MD, Iki Adachi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 1, Pages e11-e13 (January 2016) DOI: 10.1016/j.jtcvs.2015.08.031 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Transthoracic echocardiogram in the apical 4-chamber view showing a severely dilated left atrium, diminished left ventricular (LV) cavity size, and hypertrophied papillary muscles (denoted by asterisk). B, Intraoperative transesophageal echocardiogram with left ventricular assist device placement. Cannula (denoted by arrow) is seen in the left ventricular cavity. Mitral valve and papillary muscle (denoted by asterisk) are encroaching on the inflow cannula in diastole. C, Intraoperative transesophageal echocardiogram after papillary muscle resection and prosthetic mitral valve replacement demonstrating laminar flow through the mitral valve into the left ventricular inflow cannula. LA, Left atrium. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e11-e13DOI: (10.1016/j.jtcvs.2015.08.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, After establishment of cardiopulmonary bypass, the Berlin inflow and outflow cannulas are detached. The left ventricular (LV) incision is indicated with a red dotted line. B and C, The mitral valve (MV) and its apparatus are excised, and a bioprosthetic valve is placed. D and E, The ventriculotomy is reapproximated with interrupted horizontal mattress sutures over felt strips, leaving an opening for reinsertion of the Berlin inflow cannula. Ao, Aorta; PA, pulmonary artery; LAD, left anterior descending coronary artery; RV, right ventricle. Printed with permission of Texas Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e11-e13DOI: (10.1016/j.jtcvs.2015.08.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Approach to mitral valve replacement to enlarge LV cavity with LVAD placement. Printed with permission of Texas Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 2016 151, e11-e13DOI: (10.1016/j.jtcvs.2015.08.031) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions