Mitral kapak replasmanı için yen bir biliflet koruma tekniği: Lafçı'nın katlama tekniği

Abstract

Subvalvüler yapıların korunması mitral kapak replasmanı sırasında ek olarak uygulanan, düşük kardiyak debi sendromu ve ilişkili olabilecek komplikasyonların prevelansını azaltan bir prosedürdür. Her iki lifletin ya da izole posteriyor lifletin korunmasını sağlayan birden çok teknik bu zamana kadar tariflenmiştir. Biz bu yazıda mitral kapak replasmanı sırasında “Lafçı'nın anteriyor liflet katlama tekniği” adını verdiğimiz ve uyguladığımız modifiye bir biliflet koruma tekniğini tariflemeyi amaçladık.Herhangi bir rezeksiyon yapmadan tek bir dikiş ile hem kapağı anülüse sabitleyecek hem de lifletin korunmasını sağlayacak bu tekniğin kros-klemp zamanlarını kısaltan, uygun anatomiye sahip hastalarda basit ve uygulanabilir bir teknik olduğu inancındayız

Keywords

• biliflet koruma
• mitral kapak replasmanı
• cerrahi teknik

A novel bileaflet sparing technique during mitral valve replacement: Lafci’s fold down technique

Abstract

Sub-valvular apparatus preservation procedure is an additional technique to mitral valve replacement which decrease the prevalence of low cardiac output syndrome and associated complications that may be seen after mitral valve replacement. A number of surgical techniques for both bileaflet and posterior leaflet preservation have been described previously. We aimed to share how we do the bileaflet preservation with a modified technique, Lafci’s anterior leaflet fold down technique, in selected patients who underwent mitral valve replacement procedure.With absence of resection and use of same sutures for both sparing leaflet and fixing mechanical valve may shorten cross-clamping time, and so, we believe that this technique is simple, reproducible when it is appropriate for the patient’s existing anatomy.

Keywords

• bileaflet sparing
• mitral valve replacement
• surgical technique

References

1. 1. Starr A, Edwards ML. Mitral valve replacement: clinical experience with a ball prosthesis. Ann Surg 1961; 154 :726-40.
2. 2. Lillehei CW. Value of preserving chordal integrity. Both experimental and clinical data (Discussion). J Thorac Cardiovasc Surg 1963; 46: 494-5.
3. 3. Lillehei CW, Levy MJ, Bonnabeau RC. Complete mitral valve replacement preserving papillary muscle, chordae tendineae, annulus continuity. Circulation 1963; 28: 757.
4. 4. Lillehei CW, Levy MJ, Bonnabeau RC. Mitral valve replacement with preservation of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg 1964; 47: 532-43.
5. 5. Athanasiou T, Chow A, Rao C et al. Preservation of the mitral valve apparatus: evidence synthesis and critical reappraisal of surgical techniques. Eur J Cardiothorac Surg 2008; 33 :391-401.
6. 6. Sintek CF, Pfeffer TA, Kochamba GS, Khonsari S. Mitral valve replacement: technique to preserve the subvalvular apparatus. Ann Thorac Surg 1995; 59: 1027-9.
7. 7. Yun KL, Sintek CF, Miller DC et al. Randomized trial of partial versus complete chordal preservation methods of mitral valve replacement: a preliminary report. Circulation 1999; 100 :90-4.
8. 8. Natsuaki M, Itoh T, Tomita S, Furukawa K, Yoshikai M, Suda H, Ohteki H. Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg 1996; 61: 585-90.

9. 9. Miki S, Kusuhara K, Ueda Y, Komeda M, Ohkita Y, Tahata T. Mitral valve replacement with preservation of chordae tendineae and papillary muscles. Ann Thorac Surg 1988; 45: 28-34.
10. 10. David TE, Burns RJ, Bacchus CM, Druck MN. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg 1984; 88: 718-25.
11. 11. Komeda M, David TE, Rao V, Sun Z, Weisel RD, Burns RJ. Late hemodynamic effects of the preserved papillary muscles during mitral valve replacement. Circulation 1994; 90: 190–4.
12. 12. Gams E, Hagl S, Schad H, Heimisch W, Mendler N, Sebening F. Significance of the subvalvular apparatus for left-ventricular dimensions and systolic function: experimental replacement of the mitral valve. Thorac Cardiovasc Surg 1991; 39: 5-12.