Atrio-Ventricular Anastomosis

Abstract

In vascular surgery during the last few years communications have been established experimentally and therapeutically between blood vessels. Little has been done in surgery of the heart involving the formation of anastomosis between the cavities of this organ. Schepelmann 1 and Dimitrieff 2 were the first to create artificial communications between the atria or the ventricles. Neither of these workers tried to produce a new opening that would join an atrium to a ventricle.

If such an anastomosis could be created with valvular properties it would be of value in pathological changes of the valves. In stenosis of the mitral valve, for example, the blood which has been dammed back in the atrium could stream through the new pathway into the left ventricle. In insufficiency, on the other hand, the anastomosis could serve as a safety valve guarding against the rising pressure in the atrium. These points, however, remain to be settled experimentally.

Dimitrieff 2 , Cutler 3 and Souttar 4 have shown that various operations on the auricular appendage are well tolerated. The appendage also represents the shortest anatomical pathway for producing a connection between atrium and ventricle. Furthermore, by using it for the atrio-ventricular anastomosis, valvular requirements can be fulfilled. Because of its funnel shaped structure, it is most suitable for transformation into a valve and for implantation into the ventricle. In an anastomosis using the appendage, the blood will flow from a broad base to a narrow apex, whereas back flow through this structure would be difficult.