A Simple, Effective, and Inexpensive Technique for Exposure of Papillary Muscles in Minimally Invasive Mitral Valve Repair: Wakka Technique Minoru Tabata,

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Presentation transcript:

A Simple, Effective, and Inexpensive Technique for Exposure of Papillary Muscles in Minimally Invasive Mitral Valve Repair: Wakka Technique Minoru Tabata, MD, MPH, Nobuhiko Hiraiwa, MD, Yuji Kawano, MD, Daisuke Nakatsuka, MD, Satoshi Hoshino, MD The Annals of Thoracic Surgery Volume 100, Issue 3, Pages e59-e61 (September 2015) DOI: 10.1016/j.athoracsur.2015.05.044 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A small thoracotomy incision and ports for totally endoscopic mitral valve repair. It is not easy to obtain excellent exposure of papillary muscles in this limited working space. The Annals of Thoracic Surgery 2015 100, e59-e61DOI: (10.1016/j.athoracsur.2015.05.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Commercially available sterile surgical marker and attached paper ruler. (B) The ruler is cut to the proper length, rolled with 1 cm overlap, and stitched with silk sutures. (C) The handmade ring retractor is made in 30 seconds. The Annals of Thoracic Surgery 2015 100, e59-e61DOI: (10.1016/j.athoracsur.2015.05.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Papillary muscles are nicely exposed with the ring retractor inserted between anterior and posterior leaflets. (B) The posterior head of the posterolateral papillary muscle, which is often difficult to expose, is well visualized. (C) The ring retractor protects leaflets and chordae from knot pusher injury. The Annals of Thoracic Surgery 2015 100, e59-e61DOI: (10.1016/j.athoracsur.2015.05.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions