[HSF] Rt thoracotomy MVR

[Zhandong Zhou]

Ani,

In this particular case, I did both mitral valve and tricuspid valve, as 
well as right and left atrium ablation. So the incision is larger than the 
incision for mitral valve alone. I cannulated the femoral artery and vein. I 
also placed a SVC cannulae through the incision as well as a retrograde 
line. The SVC and IVC were snared through the incision when I am doing the 
tricuspid valve. I still do not have the courage not to snare the cavas.

Recently, I started using the soft tissue retractor from general surgeons 
(we call it "disc"), it can really pull the skin and soft tissue away evenly 
in all directions, so a 8cm incision will have the exposure of 12cm incision 
without it, (much better than Cardiovasion one and much cheaper). You will 
like it once you see it.

When I do mitral valve alone, the incision is about 5-6 cm, but I use a 
thoracoscopy to help visulization. I will attach a picture to show how that 
works. You can appreciate the size of the mitral valve on the screen. (this 
patient has endocarditis, so I replaced the valve.)

Hope that helps. Anything good in Boston?

Zhandong Zhou



----- Original Message ----- 
From: "Ani Anyanwu" <anianyanwu at hotmail.com>
To: <openheart-l at lists.hsforum.com>
Sent: Friday, April 11, 2008 10:14 AM
Subject: RE: [HSF] Rt thoracotomy MVR


Dr Zhou

Thanks for posting picture - excellent exposure and repair - always good to 
see a real life image rather than hear the theory. I intend to do more of 
these myself.

Reassuring to me to note though that this incision is probably up to 10cm or 
more in length (jugding from the length of the ring and cardiotomy sucker 
and that the exposure takes a square shape which will become linear, and 
longer, on retractor removal) and that ribs have been spread substantially. 
In prior posts it has been said that this surgery is easily done through a 
5cm incision.  I had my doubts as to how I personally could effect a repair 
through such an incision under direct vision.

Having seen a few of these 'mini-mitrals' come for reoperations, I often 
note a perception gap between what the surgeon feels is the length of his 
incision and the reality when you measure it (most surgeons grossly 
underestimate) - there are I suspect very few mitrals that are truly done 
via 5cm incisions without rib-spreading, as some may claim, unless robotic 
or videoscopic approaches are used.

Ani





> From: zzhoumd at pol.net> To: OpenHeart-L at lists.hsforum.com> Subject: Re: 
> [HSF] Rt thoracotomy MVR> Date: Wed, 9 Apr 2008 16:21:57 -0400> CC: > > We 
> had a good discussion about right thoracotomy approach. I attached a 
> picture of right thoracotomy mitral valve repair. This is the case I did 
> recently with ablation and closure of appendage.> > Z Zhou
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