JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mehmanesh, H.
Right arrow Articles by Lange, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mehmanesh, H.
Right arrow Articles by Lange, R.
Related Collections
Right arrow Minimally invasive surgery
Right arrow Valve disease

J Thorac Cardiovasc Surg 2002;123:96-97
© 2002 The American Association for Thoracic Surgery

Evolving Technology

Totally endoscopic mitral valve repair

Hormoz Mehmanesh, MDa, Richard Henze, MDb, Rüdiger Lange, MDa Munich, Germany

From the Departments of Cardiovascular Surgerya and Anesthesiology,b German Heart Center, Technical University of Munich, Germany.

Received for publication Nov 20, 2000. Accepted for publication June 27, 2001. Address for reprints: Hormoz Mehmanesh, MD, Department of Cardiovascular Surgery, German Heart Center, Technical University of Munich, Lazarettstr 36, Munich 80636, Germany.


   Introduction
Top
 Introduction
Clinical summary
 
Although 34 cases of endoscopic mitral valve repair with the da Vinci Surgical System (Intuitive Surgical, Inc, Mountain View, Calif) had been performed as of March 2000, a small right thoracotomy was used for all of them. A totally endoscopic mitral valve repair was performed on March 17, 2000, at our institution.


   Clinical summary
Top
 Introduction
 Clinical summary
 
A 48-year-old woman had dyspnea and tachyarrhythmia on exertion of more than 8 months' duration. Transesophageal echocardiography revealed grade IV mitral valve regurgitation caused by rupture of the chordae of the posterior leaflet and an enlarged left atrium(Figure 1). Coronary angiography showed no significant coronary disease. The pulmonary artery pressure was 51/21 mm Hg. The V wave was determined, by means of the pulmonary capillary wedge pressure, to be 36 mm Hg and the left ventricular end-diastolic pressure, 25 mm Hg.



View larger version (59K):
[in this window]
[in a new window]
  		Fig. 1. Preoperative transesophageal echocardiogram demonstrating prolapse of the posterior leaflet caused by chordal repture.

 
The operation was performed with the da Vinci Surgical System. The system consists of a surgeon's console, a patient-side cart, a high-performance 3-dimensional system, and various endoscopic instruments. By means of computer-enhanced technology, the system seamlessly translates the surgeon's hand movements at a console into corresponding micro movements of the instruments positioned inside the patient through small puncture incisions, or ports. For totally endoscopic mitral valve repair, a right-sided approach was used with four ports (Figure 2): one 12-mm port for delivery of the endoscope and three 10-mm ports, two of which accepted the instruments. The fourth port was used as the supply port for managing sutures and inserting a flexible atrial retractor secured to the upper edge of the left atrium. For extracorporeal circulation, the Heartport system (Heartport, Inc, Redwood City, Calif) was used. The right jugular vein was punctured by the Seldinger technique and a 20F cannula was introduced into the superior vena cava. The right femoral artery and vein were cannulated through the right groin. Cardioplegic arrest was established by occluding the ascending aorta with an EndoClamp catheter (Heartport) introduced via the side port of the arterial cannula through the descending aorta. After the ascending aorta had been occluded by inflation of the balloon, cardioplegic solution was administered into the aortic root from the tip of the balloon catheter. Cardioplegic arrest of the heart was achieved by application of 1500 mL of Bretschneider solution. The operation was conducted at 26°C.



View larger version (103K):
[in this window]
[in a new window]
  		Fig. 2. Incisions for port placement.

 
A quadrangular resection of the posterior leaflet was performed (Figure 3) and the gap was repaired with interrupted sutures. The repair was completed with a combined technique of interrupted and running sutures for the implantation of a flexible ring (Duran ring; Medtronic, Inc, Minneapolis, Minn). The left atrium was closed with a running suture after deairing of the heart by forcing carbon dioxide gas into the blood-filled left atrium via a suction line. The crossclamp time was 115 minutes, and the total operative time was 480 minutes. Intraoperative transesophageal echocardiography confirmed the competency of the mitral valve after the patient was weaned from cardiopulmonary bypass. The patient was transferred to the intensive care unit without any inotropic support and was extubated in the intensive care unit 8 hours after the operation. Echocardiography was performed on postoperative day 10 on the ward and confirmed the intraoperative results.



View larger version (126K):
[in this window]
[in a new window]
  		Fig. 3. Intraoperative photograph shows resection of the posterior leaflet.

 
Despite a long operative time, totally endoscopic mitral valve repair can be performed safely with the da Vinci Surgical System. More experience is needed to shorten the operative time.




This article has been cited by other articles:


Home page
 Card Surg AdultHome page
W. R. Chitwood Jr. and E. Rodriguez
Minimally Invasive and Robotic Mitral Valve Surgery
Card. Surg. Adult, January 1, 2008; 3(2008): 1079 - 1100.
[Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D. A. Murphy, J. S. Miller, D. A. Langford, and A. B. Snyder
Endoscopic robotic mitral valve surgery
J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 776 - 781.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D. A. Murphy, J. S. Miller, and D. A. Langford
Robot-assisted endoscopic excision of left atrial myxomas
J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 596 - 597.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
L. W. Nifong, W.R. Chitwood, P.S. Pappas, C.R. Smith, M. Argenziano, V.A. Starnes, P.M. Shah, and for the Multi-center Robotic Mitral Repair Group
Robotic mitral valve surgery: A United States multicenter trial
J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1395 - 1404.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
J. H. Shuhaiber
Augmented Reality in Surgery
Arch Surg, February 1, 2004; 139(2): 170 - 174.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
F. P. Casselman, S. Van Slycke, F. Wellens, R. De Geest, I. Degrieck, F. Van Praet, Y. Vermeulen, and H. Vanermen
Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically
Circulation, September 9, 2003; 108(90101): II-48 - 54.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. W. Nifong, V. F. Chu, B. M. Bailey, D. M. Maziarz, V. L. Sorrell, D. Holbert, and W. R. Chitwood Jr
Robotic mitral valve repair: experience with the da Vinci system
Ann. Thorac. Surg., February 1, 2003; 75(2): 438 - 443.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
F. P. Casselman, S. V. Slycke, H. Dom, D. L. Lambrechts, Y. Vermeulen, and H. Vanermen
Endoscopic mitral valve repair: Feasible, reproducible, and durable
J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 273 - 282.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
A. M. Gillinov and D. M. Cosgrove III
Mitral Valve Repair
Card. Surg. Adult, January 1, 2003; 2(2003): 933 - 950.
[Full Text]

Home page
 Card Surg AdultHome page
W. R. Chitwood Jr. and L. W. Nifong
Minimally Invasive and Robotic Valve Surgery
Card. Surg. Adult, January 1, 2003; 2(2003): 1075 - 1092.
[Full Text]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mehmanesh, H.
Right arrow Articles by Lange, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mehmanesh, H.
Right arrow Articles by Lange, R.
Related Collections
Right arrow Minimally invasive surgery
Right arrow Valve disease

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS