Improved exposure of the mitral valve in patients with a small left atrium

A modification of the usual approach to the mitral valve is described and illustrated. This technique employs right atriotomy and interatrial septotomy, which can be easily performed when standard left atriotomy does not provide satisfactory mitral valve exposure. While this modification is not often necessary, it can be helpful in patients with a small left atrium, especially those with a small left atrium and associated left ventricular hypertrophy.