Open Surgery Upon the Mitral Valve: Prevention of Air Embolus

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THE open approach to the mitral valve which employs extracorporeal circulation has been utilized at the Cleveland Clinic Hospital since 1956. Initially this approach was used only in the treatment of mitral insufficiency,1 later for selected cases of mitral stenosis and, recently,2 for direct replacement with the Starr-Edwards mitral valve prosthesis.3,4

Although the mitral valve has been accessible by the direct open approach for the last seven years, we have not abandoned the closed operations for pure mitral stenosis. Extracorporeal circulation that employs high-flow perfusion imposes significant time and economic factors both on the patient and on the institution. At this writing we restrict the open operations upon the mitral valve to those patients who present: (1) predominant mitral insufficiency, (2) severely calcified valves, (3) restenosis after previous surgery, and (4) evidence that mural thrombus may be present.

Our early and more recent experiences with open operations upon the mitral valve including prosthetic replacement have been reported.1–5 The purpose of this communication is twofold: (1) to commend the right-sided approach to the mitral valve, and (2) to describe a simple method that has eliminated the hazard of systemic air embolus. We are convinced that these two factors contribute appreciably toward the improving results and the increasing safety of open operations upon the diseased mitral valve.


Since 1956, 218 open operations have been performed in the Cleveland Clinic Hospital for mitral valve disease; in each, extracorporeal circulation was utilized. Originally the open procedures were restricted to patients suspected of. . .



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