Tatsuki Suguru, Hashimoto Makoto, Koshima Ryuji
Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, 8-1, Kita 49 jyo, Higashi 16 jyo, Higashi-ku, Sapporo, Hokkaido, 007-0849, Japan.
J Cardiothorac Surg. 2025 Jan 4;20(1):6. doi: 10.1186/s13019-024-03275-9.
Minimally invasive cardiac surgery for mitral regurgitation is challenging in patients with narrow chests due to limited thoracic space. The butterfly technique can prevent systolic anterior motion in patients with degenerative mitral regurgitation and redundant posterior leaflets, but it is difficult to perform via minimally invasive cardiac surgery. Few reports have described mitral valve repair using the butterfly technique or in a narrow chest. This case report demonstrates the feasibility and utility of robotically assisted mitral valve repair using the butterfly technique in a patient with a narrow chest, addressing the challenges involved through innovative port insertion and visualization.
A 70-year-old woman with a narrow chest (58 mm from spine to sternum) presented with shortness of breath on exertion. Transesophageal echocardiography revealed severe mitral regurgitation with posterior leaflet prolapse. Robotically assisted mitral valve repair was performed. Skin incisions were made in the third, fourth, and sixth intercostal spaces on the right anterior axillary line. A port for the atrial retractor was placed slightly medial to the right mid-clavicular line in the fifth intercostal space, inserted more shallowly than usual to achieve mitral valve exposure. The P2 leaflet was resected and reconstructed using the butterfly technique, followed by mitral annuloplasty with a semirigid partial band. The patient was discharged 6 days postoperatively with excellent valve function. One year later, she remained asymptomatic without obvious mitral regurgitation.
Robotically assisted mitral valve repair using the butterfly technique is feasible in patients with narrow chests. Robotic assistance facilitates mitral valve exposure and manipulation in challenging anatomical conditions through enhanced dexterity and visualization.
由于胸腔空间有限，二尖瓣反流的微创心脏手术在胸廓狭窄的患者中具有挑战性。蝴蝶技术可防止退行性二尖瓣反流和后叶冗长的患者出现收缩期前向运动，但通过微创心脏手术难以实施。很少有报告描述使用蝴蝶技术或在胸廓狭窄的情况下进行二尖瓣修复。本病例报告展示了在胸廓狭窄的患者中使用蝴蝶技术进行机器人辅助二尖瓣修复的可行性和实用性，通过创新的端口插入和可视化解决了相关挑战。
一名胸廓狭窄（从脊柱到胸骨距离为58毫米）的70岁女性出现劳力性呼吸困难。经食管超声心动图显示严重二尖瓣反流伴后叶脱垂。实施了机器人辅助二尖瓣修复术。在右腋前线第三、第四和第六肋间做皮肤切口。在第五肋间右锁骨中线稍内侧放置一个心房牵开器端口，插入比平常更浅以暴露二尖瓣。使用蝴蝶技术切除并重建P2瓣叶，随后用半刚性部分带进行二尖瓣环成形术。患者术后6天出院，瓣膜功能良好。一年后，她仍无症状，无明显二尖瓣反流。
在胸廓狭窄的患者中使用蝴蝶技术进行机器人辅助二尖瓣修复是可行的。机器人辅助通过增强灵活性和可视化，便于在具有挑战性的解剖条件下暴露和操作二尖瓣。
