Three-dimensional echocardiography–guided beating-heart surgery without cardiopulmonary bypass: A feasibility study Yoshihiro Suematsu, MD, PhD, Gerald.

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Presentation transcript:

Three-dimensional echocardiography–guided beating-heart surgery without cardiopulmonary bypass: A feasibility study Yoshihiro Suematsu, MD, PhD, Gerald R. Marx, MD, Jeffrey A. Stoll, BS, Pierre E. DuPont, PhD, Robin O. Cleveland, PhD, Robert D. Howe, PhD, John K. Triedman, MD, Tomislav Mihaljevic, MD, Bassem N. Mora, MD, Bernie J. Savord, MS, Ivan S. Salgo, MD, MS, Pedro J. del Nido, MD The Journal of Thoracic and Cardiovascular Surgery Volume 128, Issue 4, Pages 579-587 (October 2004) DOI: 10.1016/j.jtcvs.2004.06.011 Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic diagram illustrating the principle of volume mode imaging. Matrix phased array uses a matrix of crystals that can collect a pyramidal volume of data 20 times per second in real time. Appropriate 3-dimensional echocardiographic images of the ASD are displayed by means of user manipulation of a region of interest (ROI) that includes the right atrium (RA) and the left atrium. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 579-587DOI: (10.1016/j.jtcvs.2004.06.011) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The patch-deployment device, which consists of a self-expanding nitinol ring and a grip, was originally developed to navigate patches to the ASDs. Left, A 0.1-mm polytetrafluoroethylene patch has been sutured to the nitinol ring. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 579-587DOI: (10.1016/j.jtcvs.2004.06.011) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Sequential RT3DE images showing direct closure of the ASD with the semiautomatic suturing device (SD). A thread that has been passed through the rim of the ASD can be seen (4-7), and the ASD was completely closed with a knot pusher (KP). The Journal of Thoracic and Cardiovascular Surgery 2004 128, 579-587DOI: (10.1016/j.jtcvs.2004.06.011) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Sequential RT3DE images showing patch closure of the ASD with the patch-opener device and Tacker (SD). Arrows indicate the rim of the patch (2-4, 10). The location of the ASD hole can be seen through the patch. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 579-587DOI: (10.1016/j.jtcvs.2004.06.011) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 RT3DE images showing double-orifice repair of the mitral valve by using the edge-to-edge method with the semiautomatic suturing device (SD). One end of a thread has been passed through the prolapsed part of anterior mitral leaflet (AML; 3-5), and the other end has been passed through the corresponding part of the posterior mitral leaflet (PML; 6, 7). The thread was completely tied with a knot pusher (KP; 8), and a double orifice was created (9). *Two-dimensional echocardiographic image. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 579-587DOI: (10.1016/j.jtcvs.2004.06.011) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 RT3DE images showing paracommissural repair of the mitral valve by using the edge-to-edge method with the semiautomatic suturing device (SD). One end of a thread has been passed through the prolapsed part of anterior mitral leaflet (AML; 3-5). After passing the other end of the thread through the corresponding part of the posterior mitral leaflet (PML; 6), the thread was tied by using a knot pusher (KP; 7-10). *Two-dimensional echocardiographic image. The Journal of Thoracic and Cardiovascular Surgery 2004 128, 579-587DOI: (10.1016/j.jtcvs.2004.06.011) Copyright © 2004 The American Association for Thoracic Surgery Terms and Conditions