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Cardiac Reoperation with da Vinci™ Surgical System - Repair of Systolic Anterior Motion (SAM) in Hypertrophic Obstructive Cardiomyopathy (HOCM)
Daniel Tai-leung Chan, Hazaim Alwair, Amber Melvin, Evelio Rodriguez, Wiley L. Nifong, Randolph W. Chitwood, Jr.
East Carolina University, Greenville, NC, USA.
Objective: To demonstrate the technique and approach of robotic repair of SAM in a patient after previous septal myomectomy for symptomatic HOCM.
Method: A 65 year old lady with a previous history of septal myomectomy (Morrow Procedure) via median sternotomy presented with increasing shortness of breath. Echocardiogram showed SAM with moderate mitral regurgitation and increased left ventricular out flow tract gradient.
Result: Robot assisted mitral valve repair was performed in this patient. The reparative procedure consisted of resection of hypertrophic chords, reposition of the antero-lateral papillary muscle followed by annuloplasty. The post-operative TEE showed no mitral regurgitation and no LVOT gradient. Her post-operative course was uneventful.
Conclusion: Re-operations using robotic-assisted techniques are possible. In this video we present a successful repair of SAM in a patient after previous septal myomectomy for HOCM. Repair techniques included chordal resections and papillary muscle repositioning to treat papillary muscle hypertrophy and malposition. Robotic assisted surgery provides superior visualization and dexterity allowing improved access to the subvalvular apparatus.
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