auricular appendage, cutting the left aortic flap. If it is desired
to save the cusps the pulmonary artery may be dissected from the
aorta and the incision carried between the right posterior and the
anterior valve-flaps. The heart is again rotated toward the right
and the mitral ring is cut with the enterotome, which is introduced
from the left auricle into the left ventricle. The left auricular
appendage is then cut open. The heart-wall is then examined by
means of parallel vertical or horizontal incisions. The papillary
muscles are cut longitudinally from apex to base. The coronary
vessels and their branches are then examined, partly from the aorta
and partly from the incisions through the muscle.
=Prausnitz Method.= The heart is removed and held in the palm of
the left hand and two vertical incisions are made on either side
of the septum, parallel with it, and extending from base to apex.
Two other incisions are then made from base to apex on the outer
borders of the ventricles, connecting at the apex with the first
incisions. The ventricles are opened by the triangular flaps of
the anterior wall thus formed, these flaps being attached at the
base of the heart. The contents of the cavities are examined and
removed; the valvular orifices and flaps are examined, and the
pulmonary and aortic rings are cut through with the shears by
extending the two incisions made on each side of the septum, taking
care to pass between the cusps.
The heart can also be opened with the long shears alone. The
openings of the two cavæ in the right auricle are connected by
an incision. The auricular appendage is opened by a second cut.
The shears are then put through the tricuspid ring, and this with
the right ventricle is cut, the incision following the right
ventricular border. The pulmonary orifice is then opened by a cut
made along the right side of the septum. The left heart is opened
through the pulmonary veins, cutting first the auricle-wall, then
the mitral ring and ventricular wall to the apex. An incision is
then made along the left side of the septum, through the aortic
orifice into the aorta.
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