Abstract
BackgroundThere is no fully recommended methodology for surgery for Barlow’s disease. Various methods have been proposed. The aim of this study was to investigate the effectiveness of transesophageal echocardiography (TEE) measurements for selecting the optimal annuloplasty ring size and determining the length of artificial chordae in patients with Barlow’s disease who underwent robot-assisted mitral valvuloplasty (R-MVP).MethodsTen patients were included. Before R-MVP, the anesthesiologist used TEE to predict the optimal annuloplasty ring size and artificial chordae lengths that would reduce mitral regurgitation. The anesthesiolosist’s predict ring size was not presented to the surgeon intraoperatively.ResultsIn 70% (7/10) of cases, the surgeon performed mitral valve repair in full match with the anesthesiologist’s repair plan. Mitral regurgitation was controlled in 85% (6/7) of cases. In three cases, the predict annuloplasty ring size and artificial chordae length were not match between anesthesiologist and surgeon. After the operation, 90% (9/10) of patients had no residual mitral regurgitation.ConclusionsAnesthesiologist’s TEE measurements were useful for selecting the optimal annuloplasty ring size and artificial chordae length during R-MVP. TEE can play an important role in robot-assisted, minimally invasive cardiac surgery for mitral regurgitation with extensive and complex prolapse, such as in Barlow’s disease.
Highlights
There is no fully recommended methodology for surgery for Barlow’s disease
We recruited 10 consecutive patients diagnosed with severe mitral regurgitation (MR) due to Barlow’s disease who had undergone robot-assisted mitral valvuloplasty (R-MVP) at our hospital between June 2018 and April 2019
After general anesthesia induction and once the patients’ hemodynamics were stable, a single anesthesiologist certified by the Japanese Board of Perioperative Transesophageal Echocardiography measured the size of the mitral valve at the end of systole using 3D- and 2D-transesophageal echocardiography (TEE), EPIQ CVxTM with the x7-2t and x82t matrix-array transducers (Phillips, Amsterdam, Netherlands), as shown in Figs. 1 and 2
Summary
There is no fully recommended methodology for surgery for Barlow’s disease. Various methods have been proposed. The aim of this study was to investigate the effectiveness of transesophageal echocardiography (TEE) measurements for selecting the optimal annuloplasty ring size and determining the length of artificial chordae in patients with Barlow’s disease who underwent robot-assisted mitral valvuloplasty (R-MVP). Invasive cardiac surgery (MICS) has become widespread. Many institutions currently perform minimally invasive mitral valvuloplasty (MICS-MVP), with good results [1]. Robot-assisted mitral valvuloplasty (R-MVP) has made it possible to perform plastic (2020) 6:56 accepted in recent years [6,7,8]. Sizing the annuloplasty ring and determining the length of the artificial chordae are performed in diastole during hyperkalemic cardiopulmonary arrest. Our previous research suggested that sizing of the mitral annuloplasty ring should be performed in the systole [12]
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