Various atriotomy approaches in mitral valve surgery: coronary circulation types and the role in postoperative bradyarrhythmias

The article presents experimental and clinical results of the study aimed at evaluation of the risk for damage of blood supply to the sinus node in patients after surgical interventions on the mitral valve depending on the type of atriotomy. The experiment was performed on the isolated hearts where coronary circulation was filled with the thick contrast medium according to the originally designed method. The study was carried out by using the isolated cadaveric hearts whose coronaries were filled with the thick contrast medium according to the originally designed method. Following the initial X-ray studies of the coronary circulation, the atriotomy incisions were done and subsequently closed; after that, X-ray studies were repeated again to evaluate the involvement of the arteries supplying the cardiac conduction system into the incisions. Clinical part of the study consisted in the intraoperative analysis of the sinus node function before and after intervention on the mitral valve. The results of the study showed that the transseptal approach via the upper edge of the oval fossa should be avoided whereas the left atrial approach along the posterior interatrial cushion and the upper atrioseptotomy according to Guiraudon were preferable.