Creation Of Design Map For Minimally Invasive Mitral Valve Repair Using Preoperative 3d Echocardiography Findings
Hiroyuki Nishi, Kimihiro Kurose, Kohei Horikawa, Go Kanazawa, Toshiki Takahashi.
Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan.
OBJECTIVE: In patients who require mitral valve repair, it is difficult to determine the appropriate length, position, and number of artificial chordae, lesion for resection, and prosthetic ring size prior to surgery. Preoperative determination of those factors may contribute to increase the success rate of minimally invasive mitral valve repair. We developed a simple and reproducible method to determine those factors using preoperative 3D echocardiography, and assessed its effectiveness.
METHODS: Fifteen patients (10 males, mean 58.7±10.7 years old) underwent a minimally invasive mitral valve repair at our institution. Prior to surgery, we assessed the prolapse position using 3D echocardiography to decide whether to perform cutting as well as the lesion for resection. In addition, that was used to select the papillary muscle for loop attachment, and the number and positions of the loops when artificial chordae were needed. To determine annulus height (AH), we measured the distance from the papillary muscle tip to the level of the mitral annulus, which revealed that the appropriate length was 7-9 mm shorter than the AH measurement.Finally, based on the length of the anterior leaflet, we chose the appropriate prosthetic ring size.
RESULTS: Three patients had anterior leaflet prolapse, while 10 had posterior and 2 bileaflet prolapse. All patients with anterior leaflet and bileaflet prolapse, and 6 with posterior leaflet prolapse received artificial chordae. The base of the loops was attached to the anterior papillary muscle in 5 patients and posterior in 4, with the other end attached to the anterior leaflet in 3, posterior in 7, and both in 2. The mean anterolateral and posteromedial AH lengths were 23 and 27 mm, respectively. According to the length of the anterior leaflet, a 28-mm prosthetic ring was selected in 2, a 30-mm ring in 8, and a 32-mm ring in 2 cases. All mitral valve repairs were performed according to the pre-surgical plan and success was obtained in each case.
CONCLUSIONS: Using our comprehensive and reproducible strategy, it was possible to decide the appropriate minimally invasive mitral valve repair procedure prior to surgery, which led to successful results in all cases.
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