Vertical Displacement for Exposure of Obtuse
Marginals and PDA by James C. Hart, M.D.
The following displacement techniques, used in conjunction with
deep pericardial retraction sutures, the Trendelenburg position,
and table rotation, provide good vessel exposure while minimizing
cardiac manipulation and maintaining hemodynamic stability (Figure
3 and Figure 4):
1. Extend the pericardial resection laterally at the level of
2. Place warm pads in the posterior pericardial well.
3. Do not place a deep pericardial retraction suture in or suspend
the right edge of the pericardium.
4. Open the right pleural space and elevate the right sternal
edge to create space in the right chest for the rotated and displaced
heart without compressing the right ventricle and right atrium.
Excellent exposure of the lateral wall is obtained with minimal
5. Rotate and displace the heart until the apex
is under the right sternal edge. OMs and the PDA will be readily
accessible in this position.