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Usefulness of Preoperative 3D-reconstructions of CT images for the planning of minimally invasive cardiac surgery (MICS).
Masato Furui¹ , Takeki Oohashi¹ , Yutaka Kobayashi¹ , Souichirou Kageyama¹ , Arishige Kimura^1
1Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
Objective
In minimally invasive cardiac surgery (MICS), the topographic structure of skin, ribs, aorta and heart needs to be identified to minimize the skin incision and to make easier exposure. We used 3 dimension computed tomography (3D-CT) of heart with ribs and skin preoperatively to determine skin incision and intercostal incision and validated. .
Methods
We examined 26 patients who underwent mitral valvular operation with MICS and made 3D-CT to demonstrate relationship of heart, ribs, skin and nipple. And we made 3D-CT for another 27 patients to perform aortic valve replacement and evaluated them.
Results
Using our method of 3D-CT, tomographic relationship of aorta, heart(right atrium, left atrium and ventricle), ribs and skin was visualized(Fig.1,Fig.2). In each case, skin incision and penetration of intercostals space was determined and operation was performed. In most cases, we performed MICS through the 4 th intercostals thoracotomy. In some cases, the third intercostal thoracotomy was suitable to expose the mitral valve. There were no cases converting to full sternotomy. We performed aortic valve replacement through parasternal small skin incision with thoracotmoy or small skin incision with full sternotomy using 3D-CT.
Conclusions
Our method of 3D-CT enables an individual planning of the operation and a minimalization of the skin incision.
Fig.1 A example of 3D-CT, tomographic relationship of aorta, heart(right atrium, left atrium and ventricle) and ribs
Fig.2 A example of 3D-CT, tomographic relationship of ribs and skin