Excision of the LAA
As previously
described2,
7, the patient underwent general
anesthesia with a double lumen endotracheal tube for selective
single-lung ventilation, and then was placed in the supine position with
bilateral forearms alongside the body and slightly below the table to
expose the axillary regions. After right single-lung ventilation, the
procedure was begun on the left side in the fourth intercostal space on
the midaxillary line. The left-side pericardium was opened at 2 cm
posterior to the phrenic nerve to expose LAA. Then activation mapping
and ablation was performed on the epicardial surface of LAA.
After ablation, the LAA atriotomy is closed between two 4–5 mm wide
strips of Teflon felt to reinforce the fragile tissue, using a mattress
suture followed by a continuous over and over sutures to definitely
close the resection line. Then the LAA was excised at the orifice
leaving a remnant of 5 mm under gentle traction of both
sutures2.