Common Atrium

Pulmonary Vein Mouse

left atrial appendage mitral valve right pulmonary veins

Figure 4-8. The child has been placed on cardiopulmonary bypass, and the view is looking through a right atriotomy. There is no atrial septum, and the orifices of the left atrial appendage and right pulmonary veins are seen in the posterior wall of the common atrial chamber. The mitral valve is anterior to the left atrial appendage.

left atrial appendage mitral valve right pulmonary veins

Figure 4-8. The child has been placed on cardiopulmonary bypass, and the view is looking through a right atriotomy. There is no atrial septum, and the orifices of the left atrial appendage and right pulmonary veins are seen in the posterior wall of the common atrial chamber. The mitral valve is anterior to the left atrial appendage.

caud

Left Atrial Appendage

left atrial appendage common AV valve annulus tricuspid valve mitral valve

Figure 4-9. The mitral valve is anterior to the left atrial appendage. The mitral and tricuspid valves share a common annulus.

left atrial appendage common AV valve annulus tricuspid valve

Figure 4-9. The mitral valve is anterior to the left atrial appendage. The mitral and tricuspid valves share a common annulus.

caud mitral valve ceph caud

Close Cleft Mitral Valve

cleft anterior mitral leaflet

Figure 4-10. As is the case in most endocardial cushion defects, there is a cleft in the anterior mitral leaflet, and it is repaired primarily with interrupted sutures. This is important, even in the absence of mitral regurgitation, because closure of the cleft supports the anterior mitral leaflet and may prevent later development of valvular regurgitation. The repair should not be excessive, to cause iatrogenic mitral stenosis; although ideally the cleft should be closed to the free margin of the leaflet. The extent of the repair is also determined by measuring the valve orifice with sized dilators to compare these numbers to the predicted mitral orifice based on body surface area.

cleft anterior mitral leaflet

Figure 4-10. As is the case in most endocardial cushion defects, there is a cleft in the anterior mitral leaflet, and it is repaired primarily with interrupted sutures. This is important, even in the absence of mitral regurgitation, because closure of the cleft supports the anterior mitral leaflet and may prevent later development of valvular regurgitation. The repair should not be excessive, to cause iatrogenic mitral stenosis; although ideally the cleft should be closed to the free margin of the leaflet. The extent of the repair is also determined by measuring the valve orifice with sized dilators to compare these numbers to the predicted mitral orifice based on body surface area.

Dacron Patch For Atrium

Dacron patch interrupted sutures in AV valve common annulus

Figure 4-11. A knitted Dacron® patch is placed in the position of the atrial septum. Interrupted sutures are placed in the AV valve common annulus and beneath the coronary sinus adjacent to the AV node and His' bundle. The interrupted sutures near the AV valves are tied with the heart arrested with cardioplegia. The aortic cross-clamp is then removed, and the heart is allowed to beat in sinus rhythm. The sutures near the His' bundle are then tied so that normal sinus rhythm can be observed during this part of the procedure. If injury to the His' bundle occurs because of these stitches, complete heart block is seen immediately as they are tied. Offending sutures are removed and replaced. A continuous suture is then placed posteriorly and cephalad to secure the patch to the atrial wall during rewarming.

Dacron patch interrupted sutures in AV valve common annulus

Interrupted sutures beneath coronary sinus and His' bundle

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

Get My Free Ebook


Post a comment