الفهرس 
HISTORICAL BACKGROUNDOnly 14 pages are availabe for public view
 |  | from | 132 |  |  |
| | | from | 132 | | |
Abstract
The most commonly used approach to operate any mitral valve pathologies is the conventional transatrial approach done just posterior to the interatrial groove through median sternotomy. among other variants is the transverse Transseptal approach first described by Dubost et al., 1966 which offers superior exposure but may enclose some risk of arrhythmias when one considers the existence of the three inter-nodal conduction pathways by James, 1963 -although this is controversial- at least one of them namely posterior pathway, may be transected. This disputed risk was a main limitation to the wide spread of this approach.
We studied 40 patients with mitral valve disease requiring mitral valve surgery and divided them into two groups:
Group (A): Twenty patients were submitted to Dubost’s transverse transseptal approach to the mitral valve.
Group (B): Twenty Patients were submitted to Conventional left Atriotomy approach to the Mitral valve.
There was no statistical difference between the two groups as regards Age, Sex nor preoperative ECG or echocardiographic assessment of the left atrial size.
As regards the Intraoperative assessment, there was also no statistical difference in the cross-clamp time, total bypass time, surgical procedure, nor the use of inotropes. The incidence of occurrence of intraoperative arrhythmias after weaning from the bypass was slightly higher in group A than in group B but also without statistical significance.
Regarding the postoperative course, there was no statistically significant difference as regards duration of postoperative mechanical ventilation time, blood loss, total ICU stay, ICU rhythm nor the 24hr ECG monitoring before hospital discharge. The patient’s late rhythm follows up shows as well no statistically significant difference between both groups.
The exposure of the mitral valve was superior in every case done with the transverse Transseptal approach, there was no need to apply the same amount of retraction needed in the transatrial approach, on the other hand the minor disturbance in the cardiac rhythm is the only debatable disadvantage of this approach. This minor limitation is largely outweighed by the optimal exposure of the mitral valve and subvalvular apparatus provided by this approach.