Robotic Mitral Valve Surgery With Intracardiac Ultrasound Guided Septal Myectomy In A Patient With Hypertrophic Obstructive Cardiomyopathy
Sahin Senay, Umit Gullu, Muharrem Kocyigit, Cem Alhan.
Acibadem University School of Medicine, Istanbul, Turkey.
BACKROUND: This video demonstrates robotic mitral valve replacement and intracardiac ultrasound guided septal myectomy in a patient with hypertrophic obstructive cardiomyopathy and infective endocarditis.METHODS: A 32 years old female patient was operated due to infective endocarditis and mitral valve insufficiency. She had hypertrophic obstructive cardiomyopathy. A right 4th intercostal space minithoracotomy (4cm) was performed, the ports and Chitwood clamp was placed accordingly at 2nd, 5th intercostal spaces. Camera port was deployed through the mini thoracotomy. Femoral artery & vein and right jugular vein cannulation was established for cardiopulmonary bypass. Interventricular septum diameter was 2.4 cm preoperatively, there was vegetations in both mitral leaflet and left ventricular outflow tract. RESULTS: A 29 mm St. Jude mechnical valve was implanted. The septum was resected under ultrasound guidance. Postoperative measurement of the inter ventricular septum was around 1.2 cm. There was no significant left ventricular outflow tract gradient postoperatively. CC and CPB times were 62 and 112 minutes respectively. CONCLUSION: Intracardiac ultrasound guidance maybe helpful in robotic septal myectomy during mitral valve surgery. LEGEND:Figure 1: Endoscopic ultrasound probe for intraoperative measurement of the interventricular septum
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