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Repair of rheumatic mitral regurgitation in children.

Kumar AS - Ann Pediatr Cardiol (2011)

View Article: PubMed Central - PubMed

Affiliation: Pushpanjali Institute of Cardiac Sciences, Pushpanjali Crosslay Hospital, Ghaziabad, UP.

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Considering the disadvantages of prosthetic valve in the pediatric age-group, it is important for surgeons and cardiologists to be aware of the feasibility, techniques and outcomes of MV repair in this subgroup of patients... There are several publications on techniques of repair of MVs for various indications... However, a step-by-step “how to do text” with illustration can only be found in a few publications... The sternotomy incision is preferred in children with additional aortic valve pathology as well... For a superior cosmetic result a right thoracotomy is recommended for older children (15 kg or more)... Cardioplegia is delivered into the aortic root... The superior vena cava (SVC) and inferior vena cava (IVC) are looped... Chordal rupture is treated by i) reattachment of chordae ii) excision of ruptured chordae with a triangular resection of AML tip or Quadrangular resection of a PML scallop... The resultant defect is closed by a 5-0 suture. iii) By Chordal transfer... This step will show any free or ruptured chordae and residual areas of prolapse... An annuloplasty is necessary to remodel and reduce the dilated MV annulus... The AML can now be measured using the standard sizers used for mechanical valves... The atriotomy incision is now closed with 3-0 monofilament using two sutures which begin at either end of the incision... Tricuspid and aortic valve function.

No MeSH data available.


A pair of valve hooks has been used to expose the subvalvular apparatus at the anterolateral commissure of the mitral valve
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Figure 4: A pair of valve hooks has been used to expose the subvalvular apparatus at the anterolateral commissure of the mitral valve

Mentions: Two valve hooks are passed into the mitral orifice to retract the AML and PML. MS if present is noted as also the thickening of the cusps and commissural fusion.[4] Further assessment is possible after incising the commissures and separating the fusion. Now the hook can be placed around the chordae near the anterolateral commissures, one anteriorly and another posteriorly. Gentle traction exposes the chordae and anterolateral papillary muscle. [Figure 4] Chordae are separated and the papillary muscle is incised with a number 11 blade and an angled Pott's scissors is used to split the papillary muscle all the way down to its base. Care must be exercised to avoid injury to ventricular wall or separation of the papillary muscle.


Repair of rheumatic mitral regurgitation in children.

Kumar AS - Ann Pediatr Cardiol (2011)

A pair of valve hooks has been used to expose the subvalvular apparatus at the anterolateral commissure of the mitral valve
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104534&req=5

Figure 4: A pair of valve hooks has been used to expose the subvalvular apparatus at the anterolateral commissure of the mitral valve
Mentions: Two valve hooks are passed into the mitral orifice to retract the AML and PML. MS if present is noted as also the thickening of the cusps and commissural fusion.[4] Further assessment is possible after incising the commissures and separating the fusion. Now the hook can be placed around the chordae near the anterolateral commissures, one anteriorly and another posteriorly. Gentle traction exposes the chordae and anterolateral papillary muscle. [Figure 4] Chordae are separated and the papillary muscle is incised with a number 11 blade and an angled Pott's scissors is used to split the papillary muscle all the way down to its base. Care must be exercised to avoid injury to ventricular wall or separation of the papillary muscle.

View Article: PubMed Central - PubMed

Affiliation: Pushpanjali Institute of Cardiac Sciences, Pushpanjali Crosslay Hospital, Ghaziabad, UP.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Considering the disadvantages of prosthetic valve in the pediatric age-group, it is important for surgeons and cardiologists to be aware of the feasibility, techniques and outcomes of MV repair in this subgroup of patients... There are several publications on techniques of repair of MVs for various indications... However, a step-by-step “how to do text” with illustration can only be found in a few publications... The sternotomy incision is preferred in children with additional aortic valve pathology as well... For a superior cosmetic result a right thoracotomy is recommended for older children (15 kg or more)... Cardioplegia is delivered into the aortic root... The superior vena cava (SVC) and inferior vena cava (IVC) are looped... Chordal rupture is treated by i) reattachment of chordae ii) excision of ruptured chordae with a triangular resection of AML tip or Quadrangular resection of a PML scallop... The resultant defect is closed by a 5-0 suture. iii) By Chordal transfer... This step will show any free or ruptured chordae and residual areas of prolapse... An annuloplasty is necessary to remodel and reduce the dilated MV annulus... The AML can now be measured using the standard sizers used for mechanical valves... The atriotomy incision is now closed with 3-0 monofilament using two sutures which begin at either end of the incision... Tricuspid and aortic valve function.

No MeSH data available.