Adequate exposure is crucial for successful mitral valve surgery. We report simple techniques for optimizing mitral valve exposure via conventional left atriotomy. The right side of the pericardium is sutured to the chest wall after medial sternotomy and pericardiotomy. We mobilize both the superior and inferior vena cava by dissecting the pericardium on their right side. Tourniquets are placed around both venae cavae and hitched up to the left after bicaval cannulation. Then the right side of the left atrium is lifted up and exposed. A longitudinal incision of the left atrium allows excellent exposure of the mitral valve using a single retractor. We adopted these procedures for 38 consecutive patients for mitral valve plasty, and additional incisions were not required. Simple mitral plasty procedure in 18 cases required 212±32 min for operation, 120±22 min for extracorporeal circulation and 88±18 min for aortic cross clamp. We conclude that this method is simple and does not lengthen the procedure.

We conducted an opinion survey of on-site collaborators after three field work sessions during the period from 1990 to 1992. As part of our public health course, these field work sessions were implemented on a small-group basis in various settings, such as schools and local public health centers. Selfadministered questionnaires on student behavior and performance were distributed to the collaborators on the days of the student visits. Completed questionnaires were then collected by mail within a couple of weeks. The total number of respondents for the three years surveyed was 205, reflecting a response rate of 100 percent.
The following results were obtained; 1. Many collaborators admired the good behavior of the students, 2. Several respondents considered student knowledge of public health issues less adequate than they had expected, and 3. Some respondents commented on the passiveness of student involvement in their work.
These survey results provided the faculty with valuable insights on the implementation of the field work sessions.