Suchen und Finden
Mitral Valve Surgery
von: Robert S. Bonser, Domenico Pagano, Axel Haverich
Springer-Verlag, 2010
ISBN: 9781849964265 , 168 Seiten
Format: PDF
Kopierschutz: Wasserzeichen
Preis: 96,29 EUR
Mitral Valve Surgery
2
Copyright page
3
Series Preface
4
Contents
6
Contributors
8
Part I Anatomy, Pathology, and Natural Historyof Mitral Valve Disease
10
1: Surgical Anatomy of the Mitral and Tricuspid Valve
11
Introduction
11
Fibrous Skeleton of the Heart
11
Mitral Valve: The Functional Unit
13
The Structure of the Functional Unit
13
Mitral Valve Annulus
14
Mitral Valve Leaflets
15
Mitral Valve Chordae Tendinae
17
Mitral Valve Papillary Muscles
18
Physiology of the Functional Unit
18
Mitral Valve Annular Dynamics
18
Mitral Valve Leaflet Physiology
19
Mitral Valve Papillary Muscles
20
Left Ventricular Muscle
20
Summary of the Impact of Mitral Valve Physiology
20
Mitral Valve Functional Unit Co-location: Surgical Considerations
21
Tricuspid Valve: The Functional Unit
21
The Structure of the Functional Unit
21
Tricuspid Valve Annulus
22
Tricuspid Valve Leaflets
23
Tricuspid Valve Chordae Tendinae
24
Tricuspid Valve Papillary Muscles
24
Physiology of the Functional Unit
24
Tricuspid Valve Annular Dynamics
24
Tricuspid Valve Leaflet Physiology
25
Tricuspid Valve Papillary Muscle Physiology
25
Tricuspid Valve Functional Unit Co-location: Surgical Considerations
25
Right Coronary Artery
25
Conduction Tissue
25
Aortic and Mitral Valve
26
Summary
26
References
26
2: Pathology and Classification of Mitral Valve Disease
28
Introduction
28
Mitral Stenosis
28
Rheumatic Mitral Stenosis
28
Mitral Annular Calcification
29
Immune Mediated Mitral Stenosis
29
Carcinoid Heart Disease and Drug Induced Valvular Heart Disease
29
Congenital Mitral Valve Stenosis
30
Pathophysiology of Mitral Stenosis
30
Mitral Regurgitation
31
Ischemic and Functional Mitral Regurgitation
32
Mitral Valve Prolapse
32
Rheumatic Mitral Regurgitation
33
Mitral Annular Calcification
33
Infective Endocarditis
33
Congenital Mitral Regurgitation
34
Pathophysiology of the Mitral Valve Regurgitation
34
Prosthetic Heart Valves
34
Prosthetic Valve Endocarditis
35
Structural Dysfunction
35
Nonstructural Dysfunction
35
References
35
3: Chronic Mitral Regurgitation
37
Anatomy of the Mitral Valve Apparatus
37
Mechanisms of Chronic Mitral Regurgitation
38
Pathophysiology
39
Determinants of Regurgitant Volume
39
LV Mechanics in MR
39
LV Compensation
39
LV Decompensation
40
Epidemiology
40
Symptoms
40
Physical Examination
41
Laboratory Investigations
41
Electrocardiography
41
Chest Roentgenogram
41
Echocardiography
41
Etiology
42
Repairability
44
Cardiac Catheterization
44
Natural History
44
Indications for Mitral Valve Surgery
44
Surgical Considerations
46
References
46
4: Chronic Ischemic Mitral Regurgitation
49
Introduction
49
Prevalence and Prognostic Impact
49
Mechanisms of Ischemic MR
49
Impaired Contractile Function
50
Increased Leaflet Tethering
50
Annular Dilatation
51
Dynamic Nature of Ischemic MR
52
Evaluation of Patients with Ischemic MR
53
Echocardiography
53
Stress Echocardiography
53
Magnetic Resonance Imaging
54
Coronary Angiography
54
Management of Patients with Ischemic MR
54
Myocardial Revascularization
54
Cardiac Resynchronization Therapy
54
Medical Treatment
54
Surgical Approaches
55
Mitral Valve (MV)Repair
55
Mitral Valve Replacement
55
Indications for Mitral Valve Surgery
55
References
55
5: Asymptomatic Mitral Valve Regurgitation: Watchful Wait or Early Repair? Review of the Current Evidence
58
Introduction
58
Severe Mitral Regurgitation
58
Existing Guidelines
58
Current State of Valve Repair
59
What Is the Outcome of Patients with Asymptomatic Severe Mitral Regurgitation?
59
Echocardiographic Assessment
60
Severity of Mitral Regurgitation
60
Etiology and Mechanism
61
Left Ventricular Function
61
Other Abnormalities
61
The Place of Exercise Testing and Exercise Echocardiography
61
Frequency of Review
62
Studies on Improving Mitral Services
62
IS There a Need for a Randomized Study?
62
References
63
Part II Mitral Valve Repair and ReplacementTechniques
64
6: Mitral Valve Prosthesis Insertion with Preservation of the Sub-Valvar Apparatus
65
Introduction
65
Surgical Strategies for Preservation of the Atrio-Ventricular Loop During Insertion of a Mitral Prosthesis
67
Surgical Techniques
67
Annular Calcification
69
References
71
7: How I Assess and Repair the Barlow Mitral Valve: The Respect Rather Than Resect Approach
72
Definition
72
Valve Assessment
73
Echocardiographic Analysis
73
Surgical Valve Analysis
73
Free Edge Mobility
73
Excess of Tissue
74
Mucoid Degeneration
74
Surgical Strategy
74
Repair of the Posterior Leaflet
76
Leaflet Mobility
76
The Goal of a Smooth and Vertical Surface of Coaptation
77
Intermediary Surgical Test
77
Repair of the Anterior Leaflet
77
Ring Annuloplasty
77
Control of the Result
78
Surgical Control
78
Echocardiographic Control
78
References
79
8: How I Assess and Repair the Barlow Mitral Valve: The Edge-to-Edge Technique
80
Introduction
80
The Edge-to-Edge Technique for Bileaflet Prolapse in Barlow’s Disease
80
Surgical Technique and Results
81
The Edge-to-Edge Technique for Anterior Leaflet Prolapse
84
The Edge-to-Edge Technique for Commissural Prolapse
84
The Minimally Invasive Approach Option
85
Edge-to-Edge Repair and Annuloplasty
85
Double Orifice Edge-to-Edge Repair and Hemodynamics
86
Edge-to-Edge Repair and the Risk of Functional Mitral Stenosis
86
References
87
9: How I Assess and Repair the Barlow Mitral Valve
88
Valve Assessment
91
Surgical Exposure
93
Strategies for Surgical Repair
94
References
98
10: Ischemic Mitral Regurgitation
99
Introduction
99
Definitions and Mechanisms
99
Consequences of Ischemic Mitral Regurgitation
99
Surgical Treatment of Ischemic Mitral Regurgitation
101
Alternative Surgical Strategies
102
Outcome of Surgical Treatment
102
References
104
11: Minimally Invasive Mitral Valve Surgery
106
Introduction
106
Minimally Invasive Surgical Approaches
106
Right Mini-Thoracotomy
106
Robotically Assisted Right Thoracic Approach
109
Partial Sternotomy
109
Minimally Invasive Approaches: Comparison of Technical Considerations and Patient Selection
109
Results of Minimally Invasive Mitral Valve Surgery
110
Valve Repair
110
Mortality and Morbidity
110
Benefits of Minimally Invasive Mitral Valve Surgery
111
Cosmesis
111
Postoperative Pain
112
Hospital Length of Stay and Recovery
112
Transfusion
112
Wound Infection
112
Cost
112
Benefits: Summary
113
Repair Techniques
113
Posterior Prolapse
113
Triangular Resection
113
Folding Plasty
113
Anterior Prolapse
113
Commissural Prolapse
114
Recommendations
114
Future Directions
114
References
114
12: Mitral Stenosis
117
Etiology and Epidemiology
117
Pathology and Pathophysiology
117
Natural History
119
Clinical Features
120
Physical Exam and Diagnostic Tests
120
Electrocardiography
121
Chest X-Ray
121
Echocardiography
121
Intervention
121
Closed Surgical Commissurotomy
121
Open Surgical Commissurotomy
122
Percutaneous Mitral Balloon Valvuloplasty
123
Indication
125
References
127
Part III Other Conditions
130
13: Atrial Fibrillation: Non Surgical Management
131
Introduction
131
Pathophysiology and Electrophysiology
131
Clinical Classification
132
Pharmacological Agents
132
General Non surgical Management Strategies
133
Rate Control in Acute AF
133
Cardioversion in Acute AF
134
Paroxysmal AF
134
Persistent AF
135
Permanent AF
137
Nonpharmacological Treatments for AF
137
Antithrombotic Therapy
138
Future Perspectives
138
Conclusion
140
References
140
14: Ablation of Atrial Fibrillation with Cardiac Surgery
142
Introduction
142
Rationale for Surgical Ablation
142
AF Prevalence
142
AF Dangers
142
AF Mechanisms and Implications for Surgical Ablation
143
The Maze Procedure
143
New Approaches to Surgical Ablation of Atrial Fibrillation
145
Lesion Sets
145
A Review of the Available Energy Sources
145
The Left Atrial Appendage
147
Challenges and Future Directions
147
Reporting Results
147
Ablation Technology and Intraoperative Assessment
147
Minimally Invasive Approaches
147
Conclusions
148
References
148
15: Tricuspid Regurgitation: Natural History, Assessment, and Intervention
151
Natural History
151
Clinical Features
152
TR Assessment
152
Surgical Treatment
155
Patients with Annular Dilatation with or Without Regurgitation
157
Patients with Annular Dilatation with Moderate or Severe TR with Some Degree of Tethering
157
Patients with Annular Dilatation with Severe Tethering
157
Conclusion
158
References
158
Index
160
Alle Preise verstehen sich inklusive der gesetzlichen MwSt.