Ruttkay Tamas, Czesla Markus, Nagy Henrietta, Götte Julia, Baksa Gabor, Patonay Lajos, Doll Nicolas, Galajda Zoltan
Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany.
Department of Anatomy, Histology and Embryology, Laboratory for Applied and Clinical Anatomy, Semmelweis University, Budapest, Hungary.
Thorac Cardiovasc Surg. 2015 Apr;63(3):238-42. doi: 10.1055/s-0034-1389270. Epub 2014 Sep 10.
An increasing number of experimental beating heart animal studies describe simple transapical mitral valve repairs based on the direct endoscopic visualization of the left ventricle. The aim of our human cadaveric study was to develop a method for more complex transapical endoscopic procedures by on-pump heart operations.
After preparation of 20 human fresh cadavers, a standard left anterolateral minithoracotomy was performed in the fifth intercostal space and the pericardium was entered. A rigid 0 degree endoscope and the instruments were introduced through a silicon apical port. To restore the natural form of the left heart, CO2 was insufflated. To test the mitral valve competence, the left ventricle was pressure-injected with saline after each step. After transecting the chords of the A2 segment of the anterior mitral leaflet before the experimental mitral valve repair, the tendinous chord was replaced using an especially designed clip chord. The second part of the experiment consisted of a segmental excision of the P2 segment of the posterior mitral leaflet followed by a standard valvuloplasty and suture annuloplasty.
With the help of the described transapical endoscopic mitral valve repair technique, we gained direct visual information of the coaptation line of the mitral leaflets as well as the anatomy and function of the subvalvular apparatus. Using intracardiac imaging, we could perform successful transapical complex mitral repair in each case.
The minimally invasive transapical endoscopic method has the potential to offer advantages for on-pump mitral valve repair procedures even in complex mitral valve repair cases.
越来越多的实验性心脏跳动动物研究描述了基于左心室直接内镜可视化的简单经心尖二尖瓣修复术。我们人体尸体研究的目的是通过体外循环心脏手术开发一种用于更复杂经心尖内镜手术的方法。
准备20具新鲜人体尸体后，在第五肋间进行标准左前外侧小切口开胸并打开心包。通过硅质心尖端口插入一个刚性0度内窥镜和器械。为恢复左心的自然形态，注入二氧化碳。在实验性二尖瓣修复的每个步骤后，向左心室压力注入生理盐水以测试二尖瓣功能。在实验性二尖瓣修复前横断二尖瓣前叶A2段的腱索后，使用专门设计的夹式腱索替代腱索。实验的第二部分包括二尖瓣后叶P2段的节段性切除，随后进行标准瓣膜成形术和瓣环成形缝合术。
借助所描述的经心尖内镜二尖瓣修复技术，我们获得了二尖瓣叶贴合线以及瓣下装置的解剖结构和功能的直接视觉信息。使用心内成像，我们能够在每种情况下成功进行经心尖复杂二尖瓣修复。
即使在复杂二尖瓣修复病例中，微创经心尖内镜方法也有可能为体外循环二尖瓣修复手术带来优势。
