ABSTRACT
In a 39-year-old male with mitral valve endocarditis, after 6 weeks of intravenous antibiotics, echocardiography confirmed multiple vegetations on both leaflets, a flail posterior leaflet flail and contained perforation of the anterior leaflet in a windsock-like morphology. All vegetations, diseased and ruptured chords and the windsock-like contained rupture of the anterior leaflet were carefully resected via a right minithoracotomy and with femoral cannulation. Three repair techniques were blended to reconstruct the valve: (1) A large, infected portion of the prolapsing posterior leaflet was resected in a triangular fashion, and the edges were re-approximated using continuous 5-0 polypropylene sutures. (2) The anterior leaflet defect was repaired with a circular autologous pericardial patch that had been soaked in glutaraldehyde. (3) A set of artificial chords for P2 was created using CV-4 polytetrafluoroethylene sutures and adjusted under repeated saline inflation. A 38-mm Edwards Physio-I annuloplasty ring was implanted. The artificial chords were adjusted again after annuloplasty and then tied. Transoesophageal echocardiography (TEE) confirmed the absence of residual mitral regurgitation and systolic anterior motion and a mean pressure gradient of 3 mmHg. The patient was discharged after 5 days with a peripherally inserted central catheter to complete an additional 4 weeks of intravenous antibiotics and had an uneventful recovery.
Subject(s)
Echocardiography, Transesophageal , Mitral Valve , Humans , Male , Adult , Mitral Valve/surgery , Mitral Valve Annuloplasty/methods , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnosis , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnosis , Suture Techniques , Heart Valve Prosthesis Implantation/methods , Endocarditis/surgery , Endocarditis/diagnosis , Pericardium/transplantationABSTRACT
Cardiothoracic surgery demands technical excellence to achieve a successful outcome, and the loading and passing of a needle through tissue atraumatically is a fundamental skill that must be mastered. From how to hold the needle driver to loading the needle and following the curve through the tissue, there are pearls and pitfalls for each step. In this video tutorial, an experienced cardiac surgeon who has trained residents and fellows for more than 30 years demonstrates the basic concepts and techniques of passing the needle through tissue.
