초록접수 현황
| 20F-076 | Video session발표 |
3D totally endoscopic transmitral septal myectomy with anterior mitral leaflet patch augmentation
Jae Suk Yoo
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
Purpose : In patients undergoing operative intervention for hypertrophic obstructive cardiomyopathy (HOCM), intrinsic abnormalities of the mitral valve are frequently observed. Advantages of a transmitral approach to septal myectomy include a panoramic view of the septum and the exposure necessary to address concomitant mitral valve pathology. However, the transmittal approach through a conventional sternotomy requires excessive retraction of the heart for exposure. A right thoracotomy approach offers better visualization with a straight access to the mitral valve without distorting the heart. Herein, we describe our technique for transmitral septal myectomy using 3-dimensional (3D) endoscope system.
Methods : A 56-year-old lady with symptomatic HOCM was admitted for surgical treatment. Echocardiography showed left ventricular outflow tract (LVOT) obstruction (Resting/Valsalva peak pressure gradient = 54/67 mmHg), with systolic anterior motion (SAM). 3D totally endoscopic right minithoracotomy approach involved a 3-cm main incision with an 1-cm camera port. Transmitral septal myectomy was performed through the anterior mitral leaflet incision along the anterior mitral annulus, which was augmented using bovine pericardial patch.
Results : The patient remained in the intensive care unit for 18 hours, and no postoperative complications occurred. Postoperative echocardiogram showed no LVOT obstruction and only trivial mitral regurgitation. A 12-lead electrocardiogram showed a normal sinus rhythm with a left bundle branch block. The patient was discharged on the fifth postoperative day without complications.
Conclusion : 3D totally endoscopic minithoracotomy transmitral septal myectomy may be a feasible surgical option for the treatment of HOCM in selected cases as an alternative to transaortic myectomy.
Methods : A 56-year-old lady with symptomatic HOCM was admitted for surgical treatment. Echocardiography showed left ventricular outflow tract (LVOT) obstruction (Resting/Valsalva peak pressure gradient = 54/67 mmHg), with systolic anterior motion (SAM). 3D totally endoscopic right minithoracotomy approach involved a 3-cm main incision with an 1-cm camera port. Transmitral septal myectomy was performed through the anterior mitral leaflet incision along the anterior mitral annulus, which was augmented using bovine pericardial patch.
Results : The patient remained in the intensive care unit for 18 hours, and no postoperative complications occurred. Postoperative echocardiogram showed no LVOT obstruction and only trivial mitral regurgitation. A 12-lead electrocardiogram showed a normal sinus rhythm with a left bundle branch block. The patient was discharged on the fifth postoperative day without complications.
Conclusion : 3D totally endoscopic minithoracotomy transmitral septal myectomy may be a feasible surgical option for the treatment of HOCM in selected cases as an alternative to transaortic myectomy.
책임저자: Jae Suk Yoo
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
발표자: Jae Suk Yoo, E-mail : mdyoo77@gmail.com