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Closed Heart Surgery
Blind operations and access is obtained into the heart through incision on the ventricular or atrial wall.
Commonest closed heart surgery done is mitral valvotomy. After exposing the heart through a thoracotomy, a finger is inserted into the left atrium through a small incision in the auricular appendage and a Tubb's dilator is inserted into the left ventricle through a small incision in the left ventricular apex. Finger in the left atrium guides the tip of the dilator into the valve orifice and the fused cusps are separated by opening the dilator.
These days, the dilation of the stenosed valve is possible with a special balloon catheter (Balloon Valvuloplasty) which is done in the cardiac cath lab. This can avoid a thoracotomy and longer stay in the hospital. But the cost of balloon technique is very high and CMV is comparatively cheaper. Most people cannot afford for the balloon technique.
Alfieri Repair: This is advised for ischaenlic mitral regurgitation. In the area of prolapse, the anterior and posterior leaflet edges are approximated with one or two mattress
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