closed mitral valve dilation

1. Rheumatic mitral stenosis, cardiac function II or above. 2. Rheumatic activity or endocarditis has been controlled for more than 6 months. 3. Age is most suitable for 20-40 years old. 4. B-ultrasound examination of the heart, mitral valve activity is still good, no or only mild calcification; mitral valve has no or only mild insufficiency; no thrombus in the left atrium. Treatment of diseases: rheumatic mitral stenosis mitral stenosis Indication 1. Rheumatic mitral stenosis, cardiac function II or above. 2. Rheumatic activity or endocarditis has been controlled for more than 6 months. 3. Age is most suitable for 20-40 years old. 4. B-ultrasound examination of the heart, mitral valve activity is still good, no or only mild calcification; mitral valve has no or only mild insufficiency; no thrombus in the left atrium. Preoperative preparation 1. Correct heart failure. 2. Prevention and treatment of pulmonary infections. 3. Pay attention to the supplement of potassium. 4. When conditions are available, emergency preparation for intraoperative extracorporeal circulation should be done. Surgical procedure (1) Left diameter closed mitral valve dilatation 1. Position: supine position, the left chest back is 30 ° ~ 40 °. 2. Incision: The left thoracic lateral incision, through the 4th or 5th intercostal space into the chest. 3. Cut the happy bag 1~2em in front of the left phrenic nerve. The upper edge reaches the pulmonary artery and the lower edge reaches the diaphragm. The edge suture is pulled to fully reveal the left side of the heart. 4. The apex touches the diastolic tremor and verifies the diagnosis. Observe the size of the left atrial appendage and estimate whether it can be indicated by the right hand of the surgeon. 5. Start with the 1-0 non-invasive polyester thread from the right side of the root of the left atrial appendage, and sew a 4-5 needle of the ligation line for 1 week and insert the Rumel hemostat. In the apical avascular zone, the purse string is also sewn, and the hemostasis is set. 6. The left atrial appendage is cut open to indicate the finger. Cut the trabecular muscles of the auricles and remove them if there is a blood clot. 7. The right hand of the surgeon is replaced with a glove that cuts off the fingertips. The finger is disinfected and wetted with 3.8% sodium citrate solution, and then enters the left atrium from the auricular incision. The assistant gently tightens the auricle line of the ear while removing the heart ear pliers. 8. The finger refers to the mitral valve hole. Understand the size of the annulus, with or without reflux; the softness of the valve, mobility, presence or absence of calcification and thrombosis. Adjust the scale of the mitral valve dilator according to the size of the valve hole. 9. In the middle of the apical suture, cut the muscle to the endocardium. The operator left the dilator to penetrate the endocardium into the left ventricle, and the assistant tightened the suture. 10. Under the guidance of the right hand indicator, 1/3 of the dilator head passes through the mitral annulus. The long axis that is spread out is aligned with the long diameter of the mitral valve mouth, and then expanded. The expanded dilator immediately returns to the left ventricle, indicating the expansion effect. It can be expanded 2 to 3 times, each time increasing by 0.2 to 0.3 cm. Finally, it can be expanded to 3.2~3.5cm. After the expansion, the dilator was withdrawn, and the assistant ligated the apex suture. 11. The index refers to the withdrawal of the heart. Stitch or ligation of the auricular incision. 12. Cut the "ten" shaped pericardial drainage port under the left posterior of the pericardium. Intermittent suture pericardial incision for thoracic closed drainage. Suture the chest incision. (B) right diameter closed mitral valve dilatation 1. Position: supine position, right chest back height 30 ° ~ 40 °. 2. Incision: right anterolateral thoracic incision, through the fourth intercostal space into the chest. 3. Cut the happy bag 2cm in front of the right phrenic nerve and pull the edge suture. 4. If the room ditch is long enough, it should be divided into two places when dissecting. The upper incision is 1.5 to 2.0 cm; the lower incision is 0.8 to 1.0 cm in length. The distance between the two incisions should be greater than 1.0 cm and maintain the integrity of the fat pad and epicardium between the two. Both incisions are sutured as two layers of inner and outer purse. The inner sutures are all set with Rumel hemostats. 5. Cut the upper incision, enter the left index to reach the left atrium, and explore the mitral valve mouth in the same way as before. The incision enters the dilator, and under the guidance of the finger, the head 1/3 is inserted under the mitral annulus, and the expansion method is the same as before. 6. Exit the dilator first, then exit your finger and ligature the purse string separately. 7. If the chamber is short and cannot be used for 2 incisions, the fingers and dilator can be inserted into the left atrium by a single incision for expansion. 8. Suture the pericardium and close the chest, the same method as before.