| a) |
Left antero-lateral approach |
| b) |
Prepare and drape the left chest |
| c) |
Curvilinear incision between 4th and 5th interspace
from mid-sternum to mid-axillary line |
| d) |
Avoid breast tissue in females, and internal
mammary and intercostals vessels |
| e) |
Incise through subcutaneous tissue, pectoralis
major and serratus anterior muscle |
| f) |
Use a clamp to puncture through the intercostals
muscles above the 4th and 5th rib during expiration, and spread
along the rib |
| g) |
Use a large Mayo scissor to incise the intercostals
muscles along the superior aspect of the rib |
| h) |
Insert a self retaining rib spreader and dilate
as much as possible for maximal exposure |
| i) |
Proceed to perform procedures as indicated,
including internal massage, release of pericardial tamponade, hilum
hemorrhage control, repair of cardiac wound, etc. |
