RU2348364C1 - Method of surgical reduction of left atrium cavity within cardiopulmonary bypass operative prosthetics of mitral valve - Google Patents

Abstract

FIELD: medicine; cardiosurgery.

SUBSTANCE: surgical reduction of left atrium cavity within cardiopulmonary bypass operative prosthetics of mitral valve consists in uninterrupted blanket suturing on posteroinferior wall of left atrium from upper end of interatrial septum incision thus forming a fold along semi-circle fibrous ring of mitral valve and closuring of left atrial auricle. Herewith suturing of posteroinferior wall of left atrium is extended to left atrium cupula to upper end of atrium roof incision, thus forming uninterrupted circular suturing.

EFFECT: lower risk of thromboembolic and hemodynamically significant complications in postoperative period.

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Description

The invention relates to medicine, namely to cardiovascular surgery.

A known method developed by Ricardo Sinatra, which consists in a triangular resection of the wall of the left atrium [1]. There is also a method of spiral resection of the wall of the left atrium [2].

The disadvantage of these two operations is the technical complexity of their implementation and the length of time. The need to dissect the wall of the left atrium and subsequent suturing increase the time of cardiopulmonary bypass and the risk of bleeding and, therefore, lead to an increase in the number of possible complications in the postoperative period. The existing technique for reducing the cavity of the LP by suturing the ear of the LP does not significantly reduce the cavity of the left atrium.

A known method of surgical reduction of the cavity of the left atrium, which consists in the imposition of individual nodal sutures on the posterior wall of the left atrium along the semicircle of the fibrous ring of the mitral valve [3].

This method is the closest to the expected in its technical essence and the achieved result. It is selected as a prototype.

The disadvantage of this method is the formation of cavities between single sutures on the back wall of the left atrium, which can play a role in thrombosis.

The aim of the present invention is to reduce the risk of thromboembolic complications and hemodynamically significant complications in the postoperative period.

The goal is achieved by a technical solution, which is a method of surgical reduction of the cavity of the left atrium during the mitral valve prosthetics operation under extracorporeal circulation: the application of a continuous twisting suture to the posterior wall of the left atrium from the upper edge of the atrial septum creating a fold along the semicircle of the fibrous annulus of the mitral valve with suturing of the left atrial ear to the upper edge of the atrial roof incision, thereby reducing the schad low back wall of the left atrium. After the main stage of the mitral valve replacement operation is completed, the left atrium canopy is sutured with a continuous twisting suture, while the suture is a continuation of the suture from the posterior atrial wall to the upper edge of the atrial septum section. Suturing of the left atrium causes a decrease in the transverse and anteroposterior size of the atrium.

New in the proposed method is that the suture on the dome of the left atrium is the continuation of the suture from the posterior lower wall of the atrium to the upper edge of the section of the atrial septum. And connecting with each other, they form a continuous annular suture, reducing the size of the left atrium in all three planes.

Significant features showed in the inventive combination of new properties that are not explicitly derived from the prior art in this field and are not obvious to a specialist. Identical feature sets were not found in the patent and medical literature. The proposed method can be used to treat patients and avoids thromboembolic and hemodynamically significant complications.

Based on the foregoing, the technical solution of the problem proposed as an invention should be considered as meeting the criteria of “Novelty”, “Inventive step” and “Industrial applicability”.

The essence of the proposed method will be clear from the following description and the attached drawings.

Figure 1 shows a diagram of the application of a continuous suture on the posterior wall of the left atrium (1 - the place of application of a continuous suture on the posterior wall of the left atrium along the semicircle of the fibrous ring of the mitral valve).

Figure 2 shows a photograph of the left atrium with a twisted suture overlaid on the back wall (1 - a continuous suture on the posterior wall of the left atrium along the semicircle of the fibrous ring of the mitral valve; 2 - left atrioventricular opening).

Figure 3 shows a photograph of the left atrium with a twisted suture and an implanted mitral valve overlaid on the back wall (1 - a continuous suture on the posterior wall of the left atrium along the semicircle of the mitral valve fibrous ring; 2 - an implanted mechanical prosthesis).

The method is as follows: the patient is taken to the operating room. They give introductory anesthesia, intubate, cannulate the central veins and the radial artery on the left. Under conditions of neuroleptanalgesia, the surgical field is treated with an antiseptic solution, and the surgical field is delimited. Cut the skin, subcutaneous tissue, perform median sternotomy, longitudinal T-shaped pericardiotomy. The heart-lung machine is connected according to the scheme “hollow veins - aorta”. Perform general heparinization. After the onset of cardiopulmonary bypass, the ascending aorta is pinched. Hollow veins are pinched with turnstiles, access to the mitral valve (superior atriotomy) is performed: resection of the right atrial ear and access to the mitral valve with dissection of the left atrium and atrial septum are performed.

After visualization of the opening of the mitral valve and the posterior wall of the left atrium, a continuous twisting suture is applied with thread "Prolen 4/0" on the posterior wall of the left atrium from the upper edge of the atrial septum, creating a fold along the semicircle of the fibrous ring of the mitral valve with suturing of the left atrial ear edge of the incision of the atrium dome.

The next step is the mitral valve replacement according to the accepted procedure. After this, the roof of the left atrium is sutured with a continuous filament suture with “Prolen 4/0” thread, while the suture is a continuation of the suture from the posterior atrial wall to the upper edge of the atrial septum section.

Removing the clamp from the aorta. Recovery of cardiac activity. Turn off the heart-lung machine. Drainages into the pericardial cavity and anterior mediastinum. Hemostasis. Osteosynthesis of the sternum by wire ligatures. Layer wound closure. Aseptic dressing.

Example. Patient S., 53 years old. Diagnosis: Rheumatic heart disease. Complex mitral valve disease with a predominance of failure. Chronic form of atrial fibrillation. H2A. NYHA3. During hospitalization, an operation was performed - prosthesis of the mitral valve with a mechanical double-leaf prosthesis MEDING-MDM-31, radiofrequency fragmentation of the atria according to the “Labyrinth” scheme, resection of the right atrial ear, suture atrioplasty of the left atrium with suturing of the left atrial ear, plastic surgery blood circulation. The operation is completed as usual. The duration of mechanical ventilation was 16 hours, inotropic support in the postoperative period was not required. The postoperative period was uneventful. Wound healing by primary intention. On day 17, the patient was discharged from the hospital. According to ultrasound data, at discharge, the volume of the left atrium decreased from 372.82 to 147.26 ml. When discharged on an ECG, a sinus rhythm was recorded.

The proposed method was used in 15 patients and can significantly reduce the volume of the left atrium, thereby reducing the risk of thromboembolic and hemodynamic complications in the postoperative period.

List of references

1. Sinatra R., Pulitani I., Antonazzo A., Melina G. A novel technique for giant left atrium reduction. // European Journal of Cardio-thoracic Surgery, 2001, Vol. 20. - P.412-14.

2. Sugiki H., Murashita T., Yasuda K., Dot H. Novel Technique for Volume Reduction of Giant Left Atrium: Simple and Effective "Spiral Resection" Method // Annals Thoracic Surgery, 2006, Vol. 81. - P.378-80.

3. Sadatoshi Y., Takeshi S. et. al. Surgical Treatment of Giant Left Atrium Using a Combined Superior-Transseptal Approach // Annals Thoracic Surgery, 2003, Vol. 75. - P.1985-6.

Claims (1)

A method of surgical reduction of the left atrial cavity during mitral valve replacement surgery under extracorporeal circulation, which consists in the application of a continuous upholstery suture on the posterior wall of the left atrium from the upper edge of the atrial septum incision, creating a fold along the semicircle of the mitral valve fibrous ring with suturing the fact that the suture on the posterior wall of the left atrium continues to the dome of the left atrium to the upper edge of p zreza atrial roof, and form a continuous annular seam.

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