Introduction

Article Outline

• Artificial Chordae Tendineae
• Ebstein's Anomaly
• Primary Repair of Esophageal Perforation versus Esophageal Diversion
• Copyright

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Artificial Chordae Tendineae 

These three articles describe novel approaches to mitral valve repair in patients with marked redundancy or flail segment(s) of the mitral valve leaflets. Favoring the more traditional method of resecting redundant or flail segments, Hopkins presents a modification of the quadrangular resection of a portion of the posterior leaflet, as pioneered by Carpentier, accompanied by a ring anuloplasty. By contrast, proposing to preserve rather than resect redundant/flail segments, Rankin and Mohr describe and illustrate their respective methods of artificial chord placement, supplemented by ring anuloplasty, as alternative options for the management of the insufficient mitral valve.

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Ebstein's Anomaly 

The anatomic variability of Ebstein's anomaly results in a wide range of clinical presentations, from the neonate in extremis to the older child presenting for elective surgery. In this issue we have contributions from three groups that have pioneered differing surgical approaches to patients with Ebstein's anomaly. Vaughn Starnes and Brian Reemtsen from Children's Hospital Los Angeles describe right ventricular exclusion as the first stage of single ventricle palliation for the neonate with severely symptomatic Ebstein's. This approach has evolved to include fenestration of the exclusion patch. Christopher Knott-Craig from the University of Alabama at Birmingham presents his approach to biventricular repair in neonates and infants. His article emphasizes flexibility of approach, and the use of the “Sebening suture” to improve apposition of the anterior leaflet to the septum. Joseph Dearani, Emile Bacha, and José Pedro da Silva from the Mayo Clinic and the University of Sao Paulo Brazil detail the cone reconstruction of the tricuspid valve. This innovative technique, first described by Dr. da Silva, results in tricuspid leaflet tissue surrounding 360° of the right atrioventricular junction. These three articles provide excellent illustrations of a range of approaches to this challenging congenital heart defect.

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Primary Repair of Esophageal Perforation versus Esophageal Diversion 

In this issue of Operative Techniques in Thoracic and Cardiovascular Surgery Drs. Lau and Raymond provide an excellent technical overview on how to technically manage both cervical and intrathoracic esophageal perforations and the uncommon esophageal diversion procedures. Management of these life-threatening problems can be challenging. A prerequisite for operatively managing esophageal injuries is one that is flexible yet adheres to the core principles of debridement, drainage, and repair, with diversion being used if necessary. Both authors emphasize these points in their description of the operative illustrations.