9．心房・心室切開・閉鎖法

Techniques of Atrial, Ventricular Incision and Closure

心房および心室切開は弁膜症，虚血性心疾患そして先天性などに対する術式に欠かすことのできない手技であり，また切開の仕方によっては大きく視野がかわる場合もある．閉鎖法では，こちらも特殊な技術は必要ないものの，確実な閉鎖・止血が必要であることはいうまでもない．確実なアプローチはよりよい視野で手術を行うために必要であり，閉鎖術も含めしっかりと身につけなければならない手技である．成人と先天性ではやや異なる点もあるため，本稿では主に成人を対象とした切開・閉鎖法に関し述べることとする．

In this series, we describe the techniques of atrial, ventricular incision and closure. Right atriotomy is a surgical procedure necessary to expose congenital abnormalities of the tricuspid valve and other congenital heart diseases such as atrial and ventricular septal defects. Whereas, left atriotomy （e.g., left side atrial, trans-septal or superior trans-septal incisions） is a technique needed to expose mitral valve disease, frequently used during the maze procedure. And finally, left ventriculostomy is a surgical approach applied during resection of scar tissue or thrombus of ventricular aneurysm surgery, repair of the ventricular septal rupture and endoaneurysmorrhaphy.

These are known techniques that have already been described in many manuscripts and textbooks. Regarding atriotomy and ventriculostomy, the most important thing to know is how to expose the tricuspid, mitral valves and adjacent sections of the heart. Ventriculostomy uses strips of Teflon felt to strengthen the suture line and enhance hemostasis.