Atlas of Mitral Valve Repair, 1st Edition

7

Commissurotomy

There is a continued role for open mitral commissurotomy for valves that remain pliable despite rheumatic changes. The technique involves sharply dividing the fused leaflets (Fig. 7.1) and separating the fused chordae (Fig. 7.2) to the anterior and posterior leaflets (Fig. 7.3). Great care should be taken to insure that the valve is competent on closure and pliable enough to open with minimal pressure.

 

Figure 7.1 Commissural division. After the placement of stay sutures the commissure is carefully divided with a scalpel along the line of fusion next to, but not extending to, the annulus. (From Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Kirklin/Barratt-Boyes cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results, and indications. Philadelphia: Churchill Livingstone; 2003: 493.)

 

Figure 7.2 Lysis of fused chordae. (From Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Kirklin/Barratt-Boyes cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results, and indications. Philadelphia: Churchill Livingstone; 2003:493.)

P.38

 

Figure 7.3 Commissurotomy (Clip 4, Case 3)