Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
March 11, 2013
Minimally Invasive Repair of Ostium Primum ASD and cleft mitral leaflet

I have now been able to successfully repair every ASD via a minimally invasive approach. I utilize the same cannulation strategy as I would for a mini TVR.  I will utilize a femoral platform for the arterial and venous cannulation. After entering the chest via a 5-6 cm incision (4-5th ICS, lateral to the anterior axillary line), I will institute CPB, drop the lungs, then encircle both the IVC and SVC with silastic vessel loops. Since there is an ASD, the aorta needs to be cross-clamped. The operation cannot be performed fibrillating. After arresting the heart, I pull the femoral venous cannula into the IVC and then snare both the SVC and IVC.  I then open the right atrium and insert a sump suction, which has been passed via my chest tube incision, through the atriotomy and into the SVC. I then snare the SVC.  With an Ostium Primum ASD, a pericardial patch needs to be placed over the defect as well as incorporating the  coronary sinus. This means that the CS will now be draining into the left atrium. This is done to avoid injury to the conduction system (AV Node). I place a running suture on the septal edge of the tricuspid valve leaflet which extends over and beyond the CS.  Of note, prior to this, the cleft in the anterior leaflet of the MV is repaired. I believe that it is important to approximate the natural coaptation zone of the cleft leaflet. A direct approximation of the free edges may lead to valvular insufficiency. Overzealous approximation may also lead to mitral stenosis.  Mild MR is better tolerated. Enclosed are pictures of the procedure. DSCN8006 DSCN8017 DSCN8023 DSCN8033 DSCN8037

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