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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.


Complete repair. A C-shaped felt of teflon as described in the text has been used to perform an annulosplaty
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Figure 7: Complete repair. A C-shaped felt of teflon as described in the text has been used to perform an annulosplaty

Mentions: Double-armed horizontal mattress sutures are placed 2 mm behind the annulus all round the MV. Alternate white and green sutures provide clarity. The two commissural sutures are identified and held on hemostats. An appropriate-sized Carpentier mitral sizer is used to match the AML by aligning the commissural sutures against the sizer. The correct size ring is now obtained. The two commissural sutures are placed at the markers on the ring. The remaining sutures are passed through the appropriate site on the ring. When all sutures have been taken through the ring it is lowered and the sutures tied. The valve is now tested by injecting saline into the LV. Gentle pressure on the left ventricle from the surface can easily demonstrate competence of the valve. If satisfactory the LA incision can be closed [Figure 7].


Repair of rheumatic mitral regurgitation in children.

Kumar AS - Ann Pediatr Cardiol (2011)

Complete repair. A C-shaped felt of teflon as described in the text has been used to perform an annulosplaty
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Complete repair. A C-shaped felt of teflon as described in the text has been used to perform an annulosplaty
Mentions: Double-armed horizontal mattress sutures are placed 2 mm behind the annulus all round the MV. Alternate white and green sutures provide clarity. The two commissural sutures are identified and held on hemostats. An appropriate-sized Carpentier mitral sizer is used to match the AML by aligning the commissural sutures against the sizer. The correct size ring is now obtained. The two commissural sutures are placed at the markers on the ring. The remaining sutures are passed through the appropriate site on the ring. When all sutures have been taken through the ring it is lowered and the sutures tied. The valve is now tested by injecting saline into the LV. Gentle pressure on the left ventricle from the surface can easily demonstrate competence of the valve. If satisfactory the LA incision can be closed [Figure 7].

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.