초록접수 현황
| 15F-012 | 포스터 발표 |
Minimally Invasive David Operation Through the Upper Partial Sternotomy
김재현, 김재범
계명대학교 의과대학 동산의료원 흉부외과학교실
Background : Valve sparing aortic root re-implantation procedure (David operation) can avoid life-long anticoagulation or valve degeneration of prosthetic valves. Minimally invasive cardiac surgry has the potential benefits of less surgical trauma and pain, and early recovery. However, minimally invasive approaches are not routinely performed for David operation because of operative complexity.
Methods : 45 year-old female Marfan patient admitted for the treatment of aortic root aneurysm (the maximal diameter of 55mm) (Figure 1). Preoperative echocardiography showed mild aortic regurgitation and left ventricular (LV) ejection fraction 61%. Upper J partial sternotomy (up to the 3rd intercostal space) exposed the aorta and the aortic root. After ascending aortic and single right atrial venous cannulation, cardiopulmonary bypass (CPB) was started. LV vent cannula was inserted via the right upper pulmonary vein. Cardioplegia (Custadiol solution) was given selectively through the both coronary ostia. David procedure was performed as usual manners (Figure 2, 3).
Results : Cardiac ischemic and CPB time was 124 minutes and 163 minutes, respectively. Postoperative course was uneventful. Extubation, transfer to ward, and discharge took place on postoperative day 0, 1, and 8, respectively. Postoperative echocardiography revealed no aortic regurgitation with good LV function. Postoperative CT is shown in Figure 4.
Conclusion : Minimally invasive David operation can be performed safely and effectively. Preoperative CT evaluation would be a crucial part of patient selection for the application of minimally invasive approach to aortic root surgery.
Methods : 45 year-old female Marfan patient admitted for the treatment of aortic root aneurysm (the maximal diameter of 55mm) (Figure 1). Preoperative echocardiography showed mild aortic regurgitation and left ventricular (LV) ejection fraction 61%. Upper J partial sternotomy (up to the 3rd intercostal space) exposed the aorta and the aortic root. After ascending aortic and single right atrial venous cannulation, cardiopulmonary bypass (CPB) was started. LV vent cannula was inserted via the right upper pulmonary vein. Cardioplegia (Custadiol solution) was given selectively through the both coronary ostia. David procedure was performed as usual manners (Figure 2, 3).
Results : Cardiac ischemic and CPB time was 124 minutes and 163 minutes, respectively. Postoperative course was uneventful. Extubation, transfer to ward, and discharge took place on postoperative day 0, 1, and 8, respectively. Postoperative echocardiography revealed no aortic regurgitation with good LV function. Postoperative CT is shown in Figure 4.
Conclusion : Minimally invasive David operation can be performed safely and effectively. Preoperative CT evaluation would be a crucial part of patient selection for the application of minimally invasive approach to aortic root surgery.
책임저자: 김재현
계명대학교 의과대학 동산의료원 흉부외과학교실
연락처 : 김재현, Tel: 053-250-8387 , E-mail : jaemax31@gmail.com
