Experimental Mitral Valve Plasty under the Beating Heart Guided by Real-Time 3-Dimensional Echocardiography
DOI:
https://doi.org/10.1532/HSF98.20071001Abstract
Background. This study examines whether real-time 3-dimensional echocardiography can provide an image resolution to serve as a substitute for optical visualization in performing mitral valve plasty.
Methods. Three pigs were used in this study. A 3-dimensional echocardiographic system was evaluated on an epicardial surface. Beating heart mitral valve plasty was performed with a surgical stapler inserted from the apex of the left ventricle using only 3-dimensional echocardiographic visualization.
Results. The high-quality images of the mitral valve were obtained with the probe at the epicardial position. However, by inserting the surgical instrument into the left ventricle, an acoustic shadow developed on the images. The images became indistinct because of the acoustic shadow, and operation became difficult. For the mitral valve plasty, an edge-to-edge mitral valve repair was carried out using a stapler (10 mm) under the beating heart. The stapler was confirmed to seize both leaflets evenly in only 1 of the 3 pigs.
Conclusions. Real-time 3-dimensional echocardiography provided clear 3-dimensional images of the mitral valve; however, when a surgical instrument was inserted into the left ventricle, an acoustic shadow appeared on the image and made detailed confirmation difficult. Lessening or eliminating the acoustic shadow would be a key point to improve this procedure.
References
Braunberger E, Deloche A, Berrebi A, et al. 2001. Very long-term results (more than 20 years) of valve repair with Carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation 104(suppl 1): 18-11.nCondado JA, Acquatella H, Rodriguez L, Whitlow P, Velez-Gimo M, St Goar FG. 2006. Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv 67:323-5.nDavid TE, Ivanov J, Armstrong S, Rakowski H. 2003. Late outcomes of mitral valve repair for floppy valves: implications for asymptomatic patients. J Thorac Cardiovasc Surg 125:1143-52.nLiddicoat JR, Mac Neill BD, Gillinov AM, et al. 2003. Percutaneous mitral valve repair: a feasibility study in an ovine model of acute ischemic mitral regurgitation. Catheter Cardiovasc Interv 60:410-6.nLu JH, Hsu TL, Hwang B, Weng ZC. 1998. Visualization of secundum atrial septal defect using transthoracic three-dimensional echocardiography in children: implications for transcatheter closure. Echocardiography 15:651-60.nMaisano F, Torracca L, Oppizzi M, et al. 1998. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg 13:240-5.nMessas E, Pouzet B, Touchot B, et al. 2003. Efficacy of chordal cutting to relieve chronic persistent ischemic mitral regurgitation. Circulation 108(suppl II):II111-5.nSuematsu Y, Takamoto S, Kaneko Y, et al. 2003. Beating atrial septal defect closure monitored by epicardial real-time three-dimensional echocardiography without cardiopulmonary bypass. Circulation 107:785-90.nSuematsu Y, Marx GR, Triedman JK, et al. 2004. Three-dimensional echocardiography-guided atrial septectomy: an experimental study. J Thorac Cardiovasc Surg 128:53-59.nSugeng L, Weinert L, Thiele K, Lang RM. 2003. Real-time three-dimensional echocardiography using a novel matrix array transducer. Echocardiography 20:623-35.nVasilyev NV, Martinez JF, Freudenthal FP, Suematsu Y, Marx GR, del Nido PJ. 2006. Three-dimensional echo and videocardioscopy-guided atrial septal defect closure. Ann Thorac Surg. 82:1322-6n
