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Superior Transeptal Approach to Left Atrium

Thursday, October 15, 2015

2015 Resident Video Competition Award Winner

This video demonstrates the superior transeptal approach to the left atrium in a patient requiring mitral and tricuspid valve repairs.


Very good MV exposure! It looks like to me that your RA incision is very very near to SVC origin as well as SA node . Have you eventually had any problem Regarding narrowing of the SVC -RA junction? And, any problem with SA node dysfunction ? This superior septal or transeptal biatrial approach is one of the best for MV exposure . Congratulations to the author. Warm regards, Ovidio
Mini transseptal approach seems to be more useful for such exposure. It is also less traumatic than superior transseptal approach. I have seen the situation with significant bleeding on the suture line at the apex of the right atrium, behind the aorta. It was very difficult to approach this area after removing the cross clamp. carefull with this approach.
I first used the transseptal approach in the late 1970s on a 350 pound Samoan patient who had undergone two previous mitral valve replacements by other surgeons. In each previous case MV exposure, by the usual posterior approach, was poor due to the massive size of the patient and his heart. Poor exposure resulted in faulty placement of annular sutures and massive leaks. The transseptal approach gave me perfect exposure which allowed easy replacement of the valve and no subsequent leaks. This case is described in detail in my recently published medical murder mystery, Dueling in Death's Backyard, available on Amazon .com.
Thanks for video. I suggest to use left brachio-cephalic vein cannulation instead of SVC cannulation that add benefits to SVC mobilisation , therefore enhanced acces on LA roof.

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