How to do: Peppermint patch for repair of atrial or ventricular tears

Abstract

Bleeding can be troublesome through atrial cannulation sites, atriotomy, ventriculotomy or tears in atrium or ventricle. A technique is described for control of such bleeding using a pericardial patch with a hole (peppermint patch). A central hole is made in a pericardial patch through which the venous cannula or an obturator is passed. While the cannula or obturator helps to decrease or arrest the bleeding, the circumference of the patch is sutured to the musculature beyond the bleeding sites. The cannula or obturator is removed and the central hole closed, tightening the purse string inserted earlier. We have found this technique useful to control bleeding through friable right atrial wall in advanced rheumatic heart disease and friable right ventricle in adults with congenital heart disease. The need for peppermint patch can be avoided by not releasing the pericardium adherent to the atrium or ventricle in redo surgeries.