Preface; 1 Introduction; 1.1 General thoughts on endoscopic surgery; 1.1.1 The philosophy; The ideas behind it; Complexity; Experience; Valve repair -- frequency of valve replacements; 1.1.2 The team; 1.1.3 Holding out; 1.2 How to start an endoscopic program; 1.2.1 Starting conditions for endoscopic mitral valve surgery; 1.2.2 Patient-related arguments; Prognosis; Need for blood transfusion; Wound-healing disturbances; Cosmetic reason; 1.2.3 Hospital-related arguments; Marketing; Economic reasons; 1.2.4 Patient selection; 1.2.5 Teaching course
1.2.6 Starter kit for endoscopic mitral valve surgery1.2.7 Overview; 2 Anesthesiology and pain management; 2.1 Intubation and ventilation; 2.2 Pain management; 3 Technical prerequisites; 3.1 Cannulas and extracorporeal circulation; 3.1.1 Arterial cannulas (retrograde perfusion); 3.1.2 Arterial cannulas (antegrade perfusion); 3.1.3 Venous cannulas; 3.1.4 Extracorporeal circulation; 3.2 Accessories; 3.2.1 Soft-tissue retractor; 3.2.2 Arms for videoscopic camera and atrial retractor; 3.3 Instruments; 3.3.1 Atrial hook; 3.4 Sutures; 4 Preparations; 4.1 Arterial and venous cannulation
4.1.1 Femoral vessel cannulation after preparation4.1.2 Direct cannulation of the ascending aorta; 4.2 Mini-thoracotomy; 4.3 Ports; 4.4 Videoscopy; 4.4.1 The wrinkle; 4.4.2 The diameter; 4.4.3 The monitor picture; 4.4.4 Additional helpful details; 4.5 Cardioplegia; 4.5.1 Use of cardioplegia; 4.5.2 Operations under fibrillation; 4.6 Aortic clamping; 4.6.1 Endoclamping; 4.6.2 The Chitwood technique; 4.6.3 Complications; 5 Valve repair techniques; 5.1 Quadrangular resection; 5.1.1 Pathological anatomy; 5.1.2 Theoretical remarks; 5.1.3 Practical realization; Identifying the prolapse
Cutting out of the prolapseNarrowing of the annulus; Closure of the gap; 5.2 Triangular resection; 5.2.1 Pathological anatomy; 5.2.2 Theoretical remarks; 5.2.3 Practical realization; Identifying the prolapse; Cutting out the prolapse; Narrowing of the annulus; Closure of the gap; 5.3 Sliding technique; 5.3.1 Pathological anatomy; 5.3.2 Theoretical remarks; 5.3.3 Practical realization; Identifying the diseased parts; Cutting out of diseased part(s); Retiring the leaflet; Narrowing of the annulus; Sliding and refixation; 5.4 Neochords -- preformed loops; 5.4.1 Pathological anatomy
5.4.2 Theoretical remarks5.4.3 Practical realization; Identifying the diseased parts; Measurement of the chordae length; Implantation of preformed loops; 5.5 Neochords -- flexible length; 5.5.1 Pathological anatomy; 5.5.2 Theoretical remarks; 5.5.3 Practical realization; Identifying the diseased parts; Measurement of the chorda length; Implantation of flexible chords; 5.6 Artificial rings; 5.6.1 Theoretical remarks; 5.6.2 Implantation technique; 5.6.3 Complications; 5.7 Emergency exit; 5.7.1 Theoretical remarks; 5.7.2 Practical performing; 6 Tips and tricks; 6.1 Perfusion's challenge
Summary
The book describes first all practical steps necessary in a clinic from the idea of the introduction of the minimally-invasive mitral valve surgery up to practical realization of the operation program. An extensive and detailed representation of the reconstruction technologies possible today as well as the specific features of the endoscopic application allow quick learning of the surgical technology. Informative pictures as well as videosequences of the most frequent findings and the accompanying reconstruction technologies underline the practical orientation of the book
