Open heart surgery cosmetic incision and operative cooperation Defect 4o case of ventricular septal defect in five cases, two cases of mitral valve replacement, removal of left atrial myxoma 1.2 Indications and contraindications for the eight cases: indications: atrial septal defect, ventricular septal defect, mitral valve replacement and atrial myxoma removal of taboos: a high position of ventricular septal defect, aortic valve replacement, the Tetralogy four associated disorders such complex cardiac malformations, l3 surgery preparation: ① patient preparation: preoperative 1El visiting patients, reading medical records, check patients with extremity vascular brief surgical method and its advantages to the patient, the lifting of the patient’s ideological concerns in order to obtain the patient’s understanding and with the ② operating room ready: for routine adult or pediatric heart and heart devices to keep separate: medium rib retractor, closed chest control, sub-periosteal stripping. Mitral deep pull hook, prepare the dressing in vitro, which in vitro single changed Chest single for routine lateral position position cushion set. 1.4 surgical procedures and to tie l4l position and incision: left lateral position of 45 degrees, right arm wrapped fixed anesthesia shelves, gentle movements and pendulum position and protect arteriovenous needle. Avoid prolapse incision: right anterolateral incision, the surgical field routine disinfection Shop drapes cover protection film. 1.4,2 conventional chest wall incision, electrocautery to stop bleeding, and adult female patients with breast up free, into the chest through the 4th intercostal rib retractor retractor incision to expose the chest incision the pericardium in front of the phrenic nerve 2cm at the longitudinal incision of pericardium, two tonsil clamp lift the pericardium, cut with scissors, pay attention to reveal the open aortic 7x17 circle needle on the 4th thread pericardium the left edge of the chest wall. Pericardial right edge of the slit in the gauze pad for traction, canadagoose outlet, the two straight tooth forceps fixed. Exploration outside the heart: patients who wash their hands, heart outside probe, confirming the diagnosis, exact surgical plan 1.4.3 replaced without damage tweezers, two 7 × 17 (children 6 × 14) Central Plains Medical Journal in June 2oo1 28 6 -39 the heart during open heart surgery cosmetic incision surgery with the Sun Mingwei pay the Lai segment Whelan, Henan Province People’s Hospital operating room (450003), no damage do double purse-string suture stitches in the aorta anterior wall, wire tail with a thin lead hook put a thin rubber tube to clamp line the end of the pattern, with large curved vascular clamp the main pulmonary artery between the separate, small right angle clamp around the superior vena cava put the vena cava blocked with blocking the tube and sleeve, the end of the blocking clamp to live an alternate. 1.4.4 aortic cannulation: the heart cut separation of the aortic adventitia, sharp knife stab to open the aortic wall, and immediately inserted into the aortic tube, tighten the purse line clamp, cotton cord, on the 7th ligature fixed. Completely exhaust the arterial blood supply to the end of the cardiopulmonary bypass machine connected to the inferior vena cava tube plugged connection is completed, start cardiopulmonary bypass. Other cardiac surgery with open heart surgery with the conventional heart procedure. 1.4.5 closed chest: The operation completed suture the pericardium as a pericardial window, a home chest drainage tube on the right fourth intercostal space and connected to water seal bottle. Regular inventory of gauze pads, equipment, stitches correct closed chest. Discussion 2.1 good cosmetic results: incision under the edge of the right breast, female patients is not easy to expose the surgical incision, even in the summer when wearing low collar or no collar clothes do not see the incision, the small scar, if the 0/4 slip line for intradermal suture, skin flap together in good condition, no significant scar, this incision the majority of patients, especially female patients welcome. 2.2 Damage: This incision does not split sternum. Wound healing, postoperative incision pain is significantly reduced in elderly patients, but also to avoid the occurrence of complications such as sternal dehiscence. 2.3 hemostatic effect: right anterolateral thoracotomy incision without sternotomy incision and pleural suture, significantly reduce the incidence of hemorrhage, the majority of patients without blood transfusion, to avoid cross-infection caused by blood transfusion, in order to facilitate postoperative physical recovery. 24 familiar with the surgical steps: Because this incision surgical field revealed unsatisfactory Nurse to ensure that the lighting and regulating the lighting, the scrub nurse to do with the initiative, the action quickly and accurately, complete items ready, In addition, to ensure that the patient supine comfort, safety to prevent upper extremity injury and electrosurgical burns. [2O00-12 a hiss Received]