Nishi Hiroyuki, Fukui Shinya, Kitahara Mutsunori, Sakakibara Satoshi, Kakizawa Yumi
Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan.
Kyobu Geka. 2020 Jul;73(7):517-522.
In patients who require minimally invasive mitral valve repair (MICS-mitral), it is difficult to determine the appropriate length of artificial chordae, position, and number of artificial chordae. The Memo 3D Rechord, a complete prosthetic ring associated with a temporary chordal guide system comprised of yellow loops that function as a reference guide for automatically determining the height of neo-chordae. We sought to evaluate our tips for use of this system.
Five patients (1 male, mean 68 years old) who underwent MICS-mitral using artificial chordae with the Memo 3D Rechord were evaluated. Prior to surgery, we assessed the prolapse position using 3-dimensional( 3D) echocardiography to decide the number and positions of the artificial chordae. Polytetrafluoroethylene (PTFE) sutures were passed through the papillary muscles and the free margin of the prolapsed leaflet, then appropriate positioning of the PTFE chordae was performed using a saline test. The PTFE chordae were passed through the loops and the free margin of the prolapsed leaflet was brought to the posterior annulus. Then, the PTFE sutures were tied and the temporary loop system removed.
All patients had posterior leaflet prolapse. The number of the artificial chordae was 2 in 3 patients, and 1 in 2. The base of the artificial chordae was attached to the anterior papillary muscle in 3patients and posterior in 4. Additional indentation closure was required in 1 patient. All mitral valve repairs were performed successfully. Postoperative echocardiography mitral regurgitation( MR) grade was trivial in 5.
Using our technique, it was possible to decide the appropriate length and position of the artificial chordae and MICS-mitral for leaflet prolapse with the Memo 3D Rechord is a simple and reproducible method.
在需要微创二尖瓣修复术（MICS - 二尖瓣）的患者中，很难确定人工腱索的合适长度、位置和数量。Memo 3D Rechord是一种完整的人工瓣环，与一个临时腱索引导系统相关联，该系统由黄色环组成，可作为自动确定新腱索高度的参考指南。我们试图评估使用该系统的技巧。
对5例（1例男性，平均年龄68岁）使用人工腱索及Memo 3D Rechord进行MICS - 二尖瓣手术的患者进行评估。术前，我们使用三维（3D）超声心动图评估脱垂位置，以确定人工腱索的数量和位置。将聚四氟乙烯（PTFE）缝线穿过乳头肌和脱垂瓣叶的游离缘，然后通过盐水试验对PTFE腱索进行适当定位。将PTFE腱索穿过环，将脱垂瓣叶的游离缘拉至后瓣环。然后，系紧PTFE缝线并移除临时环系统。
所有患者均为后瓣叶脱垂。3例患者的人工腱索数量为2根，2例患者为1根。3例患者人工腱索的基部附着于前乳头肌，4例附着于后乳头肌。1例患者需要额外的凹陷闭合。所有二尖瓣修复均成功完成。术后超声心动图显示5例患者二尖瓣反流（MR）分级均为微量。
使用我们的技术，可以确定人工腱索和MICS - 二尖瓣修复术治疗瓣叶脱垂的合适长度和位置，Memo 3D Rechord是一种简单且可重复的方法。
