Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass: Atrial septal defect closure in a swine model Yoshihiro Suematsu,

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Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Closure of Atrial Septal Defects With the Amplatzer.

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Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass: Atrial septal defect closure in a swine model Yoshihiro Suematsu, MD, PhD, Joseph F. Martinez, DVM, Benjamin K. Wolf, BS, Gerald R. Marx, MD, Jeffrey A. Stoll, BS, Pierre E. DuPont, PhD, Robert D. Howe, PhD, John K. Triedman, MD, Pedro J. del Nido, MD The Journal of Thoracic and Cardiovascular Surgery Volume 130, Issue 5, Pages 1348-1357 (November 2005) DOI: 10.1016/j.jtcvs.2005.06.043 Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Semiautomatic suturing device. B, Suture cutting device. C, Amplatzer ASD device (AGA Medical Corp, Golden Valley, Minn). D, Patch-deployment device. E, Endoscopic stapler (Tacker, Autosuture, Norwalk, Conn). The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1348-1357DOI: (10.1016/j.jtcvs.2005.06.043) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative view. The ultrasound transducer is applied directly to the surface of the right atrium. All of the surgical devices were inserted through purse-string sutures on the right atrial appendage and right atrium. UT, Ultrasound transducer. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1348-1357DOI: (10.1016/j.jtcvs.2005.06.043) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Real-time 3-dimensional echocardiographic (RT3DE) images showing atrial septal defect (ASD) enlargement with a Kerrison bone punch. For better comprehension, the device is shown in light blue. ASD (A) (yellow arrow). Deformed rim of the ASD grasped by Kerrison bone punch (B) (red arrows). C, Increased shunt flow through the enlarged ASD. RA, Right atrium; LA, left atrium; BP, Kerrison bone punch; live 3D, RT3DE image; 2DD, 2D Doppler echocardiographic image; top, view from the top. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1348-1357DOI: (10.1016/j.jtcvs.2005.06.043) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Sequential RT3DE images showing direct closure of the ASD with the semiautomatic suturing device. For better comprehension, the device and threads are shown in light blue. ASD (A) (yellow arrows). Interrupted sutures were carefully placed around the atrial septum (B,C), and the threads were passed through the rim of the ASD (D,E). Each suture was tied with the knot pusher and the threads were cut using a suture cutting system (F). SD, Suturing device; RA, right atrium; live 3D, RT3DE image; 2DD, 2D Doppler echocardiographic image; side, view from the side; top, view from the top. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1348-1357DOI: (10.1016/j.jtcvs.2005.06.043) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Sequential RT3DE images showing device closure of the ASD with an Amplatzer septal occluder. For better comprehension, the sheath and device are shown in light blue. ASD (yellow arrow). The sheath, with the device at the tip, was advanced into the ASD (A). The left disc was deployed in the left atrium (B), and the right disc was deployed in the right atrium (C,D). RA, Right atrium; LA, left atrium; DS, delivery sheath; live 3D, RT3DE image; side, view from the side; top, view from the top. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1348-1357DOI: (10.1016/j.jtcvs.2005.06.043) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Sequential RT3DE images showing patch closure of the ASD with the patch-opener device and endoscopic stapler (SD). For better comprehension, the patch, staple, and endoscopic stapler are shown in light blue. ASD (yellow arrow). Staples placed on the patch (black arrowheads). The patch was advanced on the ASD (A,B). The stapler was advanced (C) and staples were placed to approximate the patch and the atrial septum (D,E). RA, Right atrium; LA, left atrium; ES, endoscopic stapler; live 3D, RT3DE image; side, view from the side; top, view from the top. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1348-1357DOI: (10.1016/j.jtcvs.2005.06.043) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions