ABSTRACT
Introduction: To date, totally 3D-endoscopy has primarily been employed in mitral, tricuspid, and aortic valve surgeries. Herein, we describe the first case of a pulmonary valve surgery using totally 3D-endoscopy. To the best of our knowledge, this is the first case of a totally endoscopic pulmonary valve surgery. Case report: A 56-year-old woman was provisionally diagnosed with a tumor arising from the left cusp of the pulmonary valve. Totally 3D-endoscopy was planned for tumor resection. The patient was placed in a modified right lateral decubitus position and underwent mild hypothermic cardiopulmonary bypass using the left femoral artery, right jugular vein, and right femoral vein. An on-pump beating-heart technique was used during this surgery. Trocars for the 3D-endoscopic system and surgical instruments were inserted through the third and fourth intercostal spaces. Upon incision of the pulmonary artery, the suspected tumor was revealed to be a hyperplastic left pulmonary cusp; therefore surgical resection was abandoned. The patient was discharged without any complications. Conclusion: This case demonstrates that a totally 3D-endoscopic approach may provide optimal views of the pulmonary valve. Moreover, this procedure would be a novelty in MICS.
Subject(s)
Humans , Female , Aged , Pulmonary Valve Stenosis/surgery , Cardiac Catheterization/instrumentation , Pulmonary Valve Stenosis/physiopathology , Pulmonary Valve Stenosis/diagnostic imaging , Angiography/methods , Cardiac Catheterization/methods , Radiography, Thoracic , Treatment Outcome , Ventricular Dysfunction, Right/surgery , Ventricular Dysfunction, Right/physiopathology , ElectrocardiographyABSTRACT
ObjectiveTo introduce a new technique to create a pulmonary valve biorifice for reconstruction of right ventricular outflow tract in tetralogy of Fallot (TOF),and to summarize its initial clinical experience and therapeutic effect.MethodsThe new technique regarding reconstruction of right ventricular outflow tract with a pulmonary valve biorifice was used in a total of 53 TOF cases (the observation group).The conventional technique regarding reconstruction of right ventricular outflow tract was used in other 50 TOF cases (the control group).The clinical dates of all cases were reviewed retrospectively.ResultsThe ages,weights,cardiopulmonary bypass time,cardiac arrest time,as well as the post operation ventilation support time were not different significantly between two groups.Compared with the contrul group,patients from the observation group had shorter duration of ICU stay.After operation,in the observation group,only 2 cases had large amount of pleural effusion,1 case meddle,and 8 cases little amount of pleural effusion; whereas,in the control group,the corresponding numbers were 1,5 and 17,respectively.At the time point of 1 week after operation,all patients were rechecked by echocardiography,no pulmonary valve stenosis was found.Moderate pulmonary valve regurgitation was found in 8 cases,mild regurgitation in 15 cases from the observation group; and severe regurgitation in 3 cases,moderate regurgitation in 17 cases,and mild regurgitation in 16 cases from the control group.A total of 33 cases from the observation group were rechecked at the time point of half year after operation,and moderate - mild pulmonary regurgitation were found in 3 cases.A total of 18 cases of them were rechecked 1 - year latter,no pulmonary regurgitation was found.ConclusionsThe new technique to create pulmonary valve biorifice can reduce the pulmonary valve regurgitation and postoperative pleural effusion,and improve the early outcomc.