Onan Burak, Kadirogullari Ersin, Kahraman Zeynep, Sen Onur
1 Department of Cardiovascular Surgery and Anesthesiology and Reanimation, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
2 Department of Anesthesiology and Reanimation, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Innovations (Phila). 2019 Jun;14(3):281-285. doi: 10.1177/1556984519841292. Epub 2019 May 3.
Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During "minimally invasive endoscopic" and "robotic" mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.
肥厚型心肌病中主动脉下间隔膨出是二尖瓣修复术后收缩期前向运动的潜在危险因素。尽管采取了保守治疗，收缩期前向运动仍可能导致术后二尖瓣反流和左心室流出道梗阻。在“微创内镜”和“机器人辅助”二尖瓣修复手术中，可通过经二尖瓣口同时进行间隔心肌切除术来预防收缩期前向运动。从技术上讲，传统上通过将二尖瓣前叶与其瓣环分离来暴露膨出的主动脉下间隔，使2毫米宽的瓣叶边缘附着于瓣环。然后在心肌切除术后缝合瓣叶。作为机器人手术中的一种替代技术，在二尖瓣修复手术中使用动态心房牵开器，不切开前叶即可暴露主动脉下间隔。在此，我们介绍一名患者，他使用达芬奇手术系统接受了机器人辅助二尖瓣修复术，包括后腱索植入、瓣环成形术和间隔心肌切除术，且未切开前叶。
