[HSF] Mitral Tricuspid

[Tea Acuff]

I haven't done this, but as a vertical incision similar to the one Mark described months ago I would be careful that your retraction does not tear into the angle of Koch and cause really bad bradycardia to avoid a little sinus arrhythmia. Sounds similar to the logic of a vertical (the two different verticals being, as usual, in absolute different directions) muscle sparing thoracotomy, which the users love and I also haven't done.
tea
should be plenty here to play with...


----- Original Message ----
From: "ebender001 at charter.net" <ebender001 at charter.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, October 19, 2006 11:02:10 AM
Subject: Re: [HSF] Mitral Tricuspid


I will exit the right atrium as I incise the left atrium.

Ed Bender, MD

---- prasannasimha <prasannasimha at gmail.com> wrote: 
> Ed, when you free the LA from the RA how do you expect an incision on 
> the posterior aspect of the limbus to enter the LA as you have already 
> lifted it off ?
> I actually do my right sided surgery first before cross clamping the 
> heart and then arrest the heart so I usually do the RA side first. I 
> then dissect Sondergaards groove extensively as you described and 
> operate through that.
> 
> Prasanna
> 
> 
> ebender001 at charter.net wrote:
> > A question to those now doing more tricuspid annuloplasties along with mitral repairs.  Since changing from routinely doing a superior septal approach to now doing the left atriotomy nicely described and filmed by Steve Bolling (ie, mobilizing the right atrium off the left atrium up to the septum), I have much less problematic bradycardia after mitral repair.  When I place a tricuspid annuloplasty ring, I have been ambivalent between my satisfaction with the latter technique and making a seperate right atriotomy for the tricuspid versus a right atriotomy/trans-septal technique for both valves.  I was thinking about doing a trans-septal approach, but instead of cutting across the superior aspect of the limbus of the fossa ovalis, I would mobilize the left atrium off the right atrium and direct the incision across the posterior aspect of the limbus into the freed up left atrium and come across the dome of the left atrium.  Has anyone done this, and, if so, have there been
 any pitfalls in closure of the incision?
> >
> > Thanks,
> >
> > Ed Bender, MD 
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