SURGICAL exposure of the mitral valve, whether approached from the left or the right, has, in the experience of most surgeons, been less than ideal. The author prefers the left-sided approach except in cases where the aortic or tricuspid valves also require surgery.
When the valve is approached from the left, its exposure is frequently perturbing because the plane of the valve slopes caudad, away from the surgeon's line of vision. Furthermore, the margin of atrial wall remaining between the usual anterolateral atriotomy incision and the atrioventricular groove forms a ledge which overhangs the valve and hides it unless this flap is firmly and widely retracted. The fragility of this tissue presents a serious hazard to use of any of a variety of standard clamps or retractors which easily cause tears or lacerations.
The retractor-clamp described here (Fig 1) is designed to gently but firmly clamp a broad arc of