Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Multimed Man Cardiothorac Surg. 2024 Aug 30;2024. doi: 10.1510/mmcts.2024.047.
Transmitral myectomy for hypertrophic obstructive cardiomyopathy is compatible with minimally invasive surgery compared with traditional transaortic access. It has often been performed in conjunction with mitral valve replacement or temporary detachment of the anterior leaflet from its annulus. We present a novel approach: longitudinal incision at the midline of the anterior mitral leaflet for septal myectomy. The procedure is ideally conducted endoscopically or robotically through the right chest. Cardiopulmonary bypass is established in the usual manner. After cardioplegic arrest, the mitral valve is exposed, and the anterior mitral leaflet is incised longitudinally at the midline. Both parts of the leaflet are tentatively fixed to the atrial wall with sutures to keep them open. Using the look-up mode of a 30° scope, the right cusp of the aortic valve is observed. Myectomy is initiated close to the aortic annulus using the pure-cut mode of electrocautery and scissors, then extended apically as necessary. After myectomy, the anterior leaflet is reapproximated with interrupted sutures. This technique is simpler than the detachment of the anterior leaflet and does not require patch materials that could lead to durability issues for the reconstruction of the anterior leaflet.
经二尖瓣切除术治疗肥厚型梗阻性心肌病与传统经主动脉方法相比，更适合微创手术。该手术常与二尖瓣置换术或前瓣叶与瓣环的临时分离联合进行。我们提出了一种新方法：在二尖瓣前叶的中线上作纵向切口，进行室间隔切除术。该手术最好通过右侧胸部的内镜或机器人进行。以常规方式建立体外循环。心脏停搏后，暴露二尖瓣，在中线上作二尖瓣前叶的纵向切口。用缝线将瓣叶的两部分暂时固定到心房壁上，以保持其打开。使用 30°镜的查找模式，观察主动脉瓣的右瓣叶。用电切和剪刀的纯切模式在靠近主动脉瓣环处开始进行切除术，然后根据需要向上延伸。心内膜下切除术后，用间断缝线重新吻合前瓣叶。与前瓣叶分离相比，该技术更简单，且不需要补片材料，这可能会导致前瓣叶重建的耐久性问题。
