Innovative techniques of left atrial exposure in minimally invasive mitral valve repair.

Various atrial retractors have been developed to achieve optimal exposure of mitral valve in minimally invasive surgery. We introduce our technique of only using retraction sutures to expose mitral valve. This method is simple, efficient, and provides good exposure of the left atrium without causing traumatic injury.

Totally endoscopic mitral valve repair without robotic assistance: A case report.

INTRODUCTION: Totally endoscopic mitral valve repair (TEMVR) is the highest level of minimally invasive cardiac surgery (MICS). It brings many benefits to patients but the downside is that a robotic system is always required. The deployment of robotic surgery is very complicated and expensive. Therefore, we improvised, making it possible to perform TEMVR without the aid of a robotic system. PRESENTATION OF CASE: A 66-year-old male patient presented with severe mitral valve regurgitation due to posterior leaflet prolapse. He was treated with TEMVR without robotic assistance. No chest incision was over 1.2 cm. The repair techniques included posterior leaflet resection and annuloplasty with ring implantation. DISCUSSION: A midline sternotomy is still the standard approach for mitral valve repair. In recent years, MICS has gradually replaced conventional surgery with the most advanced strategy being totally robotic mitral valve repair. However, complex surgical techniques and high cost make it less accessible for the majority of patients. Instead of using robot, we improved mitral valve exposure techniques, surgical port placement and therefore were able to perform TEMVR with MICS instruments. CONCLUSION: TEMVR without robotic assistance is a safe, effective and cost-efficient procedure, which can be adopted in most cardiac centers.

High-frequency Coastal Overwash Deposits from Phra Thong Island, Thailand.

The 26th December 2004 Indian Ocean Tsunami (IOT) emanated from an Mw 9.2 earthquake that generated a 1600 km-long rupture along the Sumatran Megathrust and generated tsunami waves up to 30 m high. The IOT directly impacted the Bay of Bengal and east Africa, with over 283,000 people perishing. At the time, this catastrophic event was considered unprecedented and sparked intense investigations to test this claim. It is now believed that four pre-2004 IOT events have occurred in the last 2500 years, recurring every 550 to 700 years. Much of this information comes from Phra Thong Island, Thailand, where a sequence of four stacked sandsheets separated by organic units has been recognised and compared to the 2004 IOT event. Recently, ground-penetrating radar on Phra Thong Island identified a region that could not be explained by the known stratigraphy. The stratigraphy of the area was investigated from auger cores and pits, and several previously-unrecognised sandsheets were identified and compared to the known tsunami sandsheets. The proximity of the newly-recognised sandsheets to the palaeo-coastline of Phra Thong Island does not preclude the impacts of localised storms in sandsheet emplacement or that tsunamigenic earthquake recurrence may have been more frequent in the past.