Mitral annuloplasty with the interatrial groove-left atrial dome approach in a patient with Marfan syndrome

The most commonly used approaches for MV surgery is the right atrium-atrial septum or interatrial groove approach, which can achieve satisfactory exposure in most cases; However, for special cases such as patients with a small LA, pericardial adhesions, or deep chest, it may be difficult to obtain satisfactory exposure with the conventional approach.

The patient in this case had a thoracic deformity. The LA was compressed by the thoracic spine and an aortic sinus tumor, which significantly reduced the anteroposterior diameter of the LA. It would have been difficult to obtain satisfactory MV exposure through the conventional approach. Some scholars have performed MV surgery through the left atrial dome approach and achieved.

good results [1, 2], and this approach is also suitable for patients with a small LA [3]. However, the patient had an aortic sinus aneurysm, which narrowed the gap between the aorta and the SVC. A simple left atrial dome incision would be too narrow to obtain satisfactory exposure. Therefore, we severed the SVC and combined the interatrial groove and left atrial dome approaches. This method can effectively increase exposure of the operative field and improve the surgical results, without complications such as arrhythmia or conduction block after the operation. Some authors believe that for patients with a small LA, division of the SVC for extended left atriotomy in MV operations is a viable approach [4, 5].

In summary, the interatrial groove-left atrial dome approach is an option for patients with a small LA for whom it is difficult to expose the MV.

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