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ICVTS on-line discussion B LV injection testing for MV repair in simultaneous aortotomy setting

University of Ain-Shams, Faculty of Medicine, #6-Geem-MGWRA 8, MAY 15 City, Cairo 11426, Egypt

Intraoperative saline injection leak test – a simple method to assess mitral valve repair when a simultaneous aortotomy does not allow pressurization of the left ventricle

eComment: I’ve read with much interest the article by Nakajima et al. about an intraoperative saline injection leak test [1].

The extent and the nature of the aortotomy incision were not exactly delineated or defined in the series of patients presented. Was the aortotomy incision carried down deep into the non-coronary sinus as it is the case of aortic valve procedures? In such a case, the aorta would not be able to hold the Foley’s catheter balloon in place, especially during pressurization of the LV with saline injection.

Also, was the Foley’s balloon inserted into the LVOT beneath the aortic ‘annulus’? Pressurizing the LV in such a case would necessarily push the balloon against the continuation of the aortic curtain into the AML, in fact pushing the AML towards the central mitral valve orifice, some sort of a passive posterior advancement of the AML.

I query what would such effects of altering the aortic ‘annulus’ configuration – during testing – pushing the AML laterally, and producing ‘confounded’ results of test competency, thus greatly undermining its validity. Especially in cases where such a configuration of the aortic root is not likely to be maintained during subsequent aortic valve procedures – aortic valve repair for example.

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1. Nakajima M, Tsuchiya K, Okamoto Y, Suetsugu F. Intraoperative saline injection leak test – a simple method to assess mitral valve repair when a simultaneous aortotomy does not allow pressurization of the left ventricle. Interact CardioVasc Thorac Surg 2007; 6:580–582.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nasser F. Abou’Seada Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Abou’Seada, N. F. Search for Related Content PubMed PubMed Citation Articles by Abou’Seada, N. F. Related Collections Related Article