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E-raamat: Operative Mitral and Tricuspid Valve Surgery

  • Formaat: EPUB+DRM
  • Ilmumisaeg: 11-Jan-2019
  • Kirjastus: Springer London Ltd
  • Keel: eng
  • ISBN-13: 9781447142041
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  • Formaat: EPUB+DRM
  • Ilmumisaeg: 11-Jan-2019
  • Kirjastus: Springer London Ltd
  • Keel: eng
  • ISBN-13: 9781447142041

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Disease of the mitral and tricuspid valves is a common disorder affecting approximately 3% of the population. Recent improvements in the understanding of the pathophysiology of the disease processes affecting these valves have led to significant changes in the management strategies applied, with better outcomes. The field of mitral and tricuspid valve surgery continues to expand with the development of new techniques and operations as well as the refinement of well-established surgical procedures. Operative Mitral and Tricuspid Valve Surgery will systematically cover all the main topics involved in the current practice of an adult cardiac surgeon, performing operations on the mitral and tricuspid valve. Each chapter will be structured to include a step-by-step approach to the peri-operative management and surgical technique pertaining to each pathological process affecting the mitral and tricuspid valves. Importantly, there will be a section on the basic sciences related to the anatomy and physiology of the mitral and tricuspid valves, and a further section on pre-operative imaging of these valves, illustrating the variety of pathologies encountered. The book will be relevant to all adult cardiac surgeons, performing mitral and tricuspid valve surgery, at any stage of their career. It will provide them with a structured system to approach all pathologies of the mitral and tricuspid valves. Adult cardiologists and cardiac intensive care unit specialists will also find this book useful in terms of the management of these patients, as they are integral to the cardiac surgical process. Its concise, yet complete coverage of the important topics make it the ideal guide to answer the key questions involved in operating on the mitral and tricuspid valves. The data and body of knowledge presented in this book is based on the practice of a recognized international leader in the field, who has been performing and evolving these techniques for over 25 years.

Spanning the topics involved in the current practice of an adult cardiac surgeon, this book offers a step-by-step approach to the peri-operative management and surgical technique specific to each pathological process affecting the mitral and tricuspid valves.
1 Anatomy and Physiology of the Mitral Valve
1(20)
Introduction
1(2)
Historical Oversight
3(3)
Anatomy
6(12)
The Chordae Tendineae and Papillary Muscles
7(5)
The `Annulus'
12(2)
Abnormal Anatomy
14(2)
The Leaflets
16(2)
Embryological Development of the Atrioventricular Valves
18(2)
The Relationship with the Left Atrium and Ventricle
20(1)
Summary
20(1)
Recommended Reading
20(1)
2 Echocardiography of the Mitral and Tricuspid Valves
21(36)
Introduction
21(1)
Echocardiographic Anatomy of the Mitral Valve
22(4)
Mitral Annulus
22(1)
Chordae Tendineae
23(1)
Papillary Muscles
23(1)
Functional Mitral Anatomy
23(3)
Trans-thoracic Echocardiography
26(5)
M-Mode Echocardiography
26(1)
Two-Dimensional Trans-thoracic Echocardiographic Views of the Mitral Valve
26(5)
Three-Dimensional Trans-thoracic Echocardiography
31(1)
Trans-oesophageal Echocardiography
31(13)
Three-Dimensional Trans-oesophageal Echocardiography of the Mitral Valve
43(1)
Doppler Echocardiography
44(5)
Colour Flow Doppler
44(1)
Regurgitant Jet Area
45(1)
Vena Contracta
45(1)
Proximal Isovelocity Surface Area (PISA)
46(2)
Pulmonary Vein Flow
48(1)
Left Ventricular Size and Function
49(1)
Left Atrial Size and Pulmonary Pressures
50(1)
Post-cardiopulmonary Bypass Echocardiography
50(1)
Exercise Stress Echocardiography
51(1)
Echocardiography of the Tricuspid Valve
51(3)
Regurgitant Jet Area
53(1)
Vena Contracta
54(1)
PISA Analysis
54(1)
Hepatic Vein Flow
54(1)
Recommended Reading
54(3)
3 Indications for Surgery on the Mitral and Tricuspid Valves
57(8)
Introduction
57(1)
Mitral Regurgitation
57(2)
Mitral Stenosis
59(1)
Tricuspid Regurgitation
60(1)
Tricuspid Stenosis
61(1)
Infective Endocarditis
61(1)
Atrial Fibrillation
62(1)
Recommended Reading
62(3)
4 Operative Set Up, Exposure and Analysis of the Mitral and Tricuspid Valves
65(14)
Introduction
65(1)
Positioning of the Patient on the Operating Table
65(1)
Surgical Incision
66(9)
Exposure of the Mitral Valve
67(8)
Minimally Invasive Approach to the Mitral and Tricuspid Valves
75(4)
Robotic Mitral Valve Surgery
77(2)
5 Mitral and Tricuspid Valve Operative Techniques
79(34)
Introduction
79(1)
Mitral Valve Operative Techniques
79(22)
Annular Techniques
79(3)
Leaflet Techniques
82(11)
Chordal Techniques
93(3)
Papillary Muscle Techniques
96(1)
Mitral Valve Replacement
97(4)
Tricuspid Valve Operative Techniques
101(5)
Annular Techniques
101(2)
Leaflet Techniques
103(1)
Chordal Techniques
104(1)
Tricuspid Valve Replacement
105(1)
Atrial Fibrillation Surgery
106(7)
6 Annular Dilatation
113(10)
Case History
113(1)
Echocardiography Findings
113(1)
Pathophysiology
114(3)
Left Atrial Enlargement
114(1)
Left Ventricular Enlargement
114(3)
Surgical Strategy
117(2)
Choosing the Appropriate Size Ring
119(1)
Surgical Technique
119(1)
Post-operative Echocardiogram
120(1)
Comment
121(1)
Recommended Reading
121(2)
7 Posterior Mitral Valve Leaflet Prolapse
123(16)
Case History
123(1)
Echocardiography Findings
123(1)
Pathophysiology
123(3)
Surgical Strategy
126(7)
Chordal Insertion/Replacement
126(2)
Triangular Resection
128(1)
Leaflet Plication
129(1)
Quadrangular Resection
129(4)
Surgical Technique
133(2)
Post-operative Echocardiogram
135(1)
Comment
136(1)
Recommended Reading
136(3)
8 Anterior Mitral Valve Leaflet Prolapse
139(14)
Case History
139(1)
Echocardiography Findings
139(2)
Surgical Strategy
141(7)
Chordal Replacement
141(1)
Chordal Transposition
142(2)
Flip-Over Technique
144(1)
Chordal Shortening
145(1)
Papillary Muscle Repositioning
146(1)
Leaflet Resection
147(1)
Leaflet Plication
147(1)
Edge-to-Edge Technique
147(1)
Surgical Technique
148(2)
Post-operative Echocardiogram
150(1)
Comment
151(1)
Recommended Reading
151(2)
9 Bi-leaflet Prolapse
153(8)
Case History
153(1)
Echocardiography Findings
153(1)
Surgical Strategy
153(4)
Surgical Technique
157(2)
Post-operative Echocardiogram
159(1)
Comment
159(1)
Recommended Reading
160(1)
10 Commissural Prolapse
161(8)
Case History
161(1)
Echocardiographical Findings
161(1)
Surgical Strategy
161(4)
Commissural Closure
163(1)
Chordal Replacement
164(1)
Leaflet Resection
164(1)
Papillary Muscle Shortening
165(1)
Surgical Technique
165(2)
Post-operative Echocardiogram
167(1)
Comment
168(1)
Recommended Reading
168(1)
11 Ischaemic Mitral Regurgitation
169(18)
Case History
169(1)
Echocardiographical Findings
169(1)
Pathophysiology
170(3)
Surgical Strategy
173(9)
Coronary Artery Bypass Grafting
173(1)
Reduction Annuloplasty
173(2)
Leaflet Extension
175(1)
Chordal Cutting
175(1)
Papillary Muscle Relocation
176(1)
Papillary Muscle Sling
177(1)
Ventricular Techniques
177(2)
Mitral Valve Replacement
179(3)
Surgical Technique
182(1)
Post-operative Echocardiogram
183(2)
Comment
185(1)
Recommended Reading
185(2)
12 Mitral Valve Infective Endocarditis
187(10)
Case History
187(1)
Echocardiographical Findings
187(1)
Pathophysiology
188(1)
Surgical Strategy
189(5)
Indications for Surgery
189(1)
Leaflet Reconstruction
190(2)
Annular Reconstruction
192(2)
Surgical Technique
194(1)
Post-operative Echocardiogram
195(1)
Comment
195(1)
Recommended Reading
196(1)
13 Extensive Mitral Annular Calcification
197(14)
Case History
197(1)
Echocardiographical Findings
197(1)
Pathophysiology
198(3)
Surgical Strategy
201(5)
Mitral Valve Repair Without Annular Decalcification
201(1)
Annular Decalcification and Reconstruction
202(1)
Mitral Valve Replacement Without Annular Decalcification
203(3)
Surgical Technique
206(2)
Post-operative Echocardiogram
208(1)
Comment
209(1)
Recommended Reading
209(2)
14 Rheumatic Mitral Valve Disease
211(10)
Case History
211(1)
Echocardiographical Findings
211(1)
Pathophysiology
212(1)
Surgical Strategy
213(3)
Increasing Leaflet Mobility
214(1)
Leaflet Augmentation
215(1)
Chordal Replacement
216(1)
Surgical Technique
216(2)
Post-operative Echocardiogram
218(1)
Comment
219(1)
Recommended Reading
219(2)
15 Systolic Anterior Motion of the Mitral Valve
221(12)
Case History
221(1)
Echocardiographical Findings
221(1)
Pathophysiology
222(3)
Surgical Strategy
225(4)
Post-mitral Repair SAM
227(2)
Surgical Technique
229(2)
Post-operative Echocardiogram
231(1)
Comment
232(1)
Recommended Reading
232(1)
16 Tricuspid Regurgitation
233(14)
Case History
233(1)
Echocardiographical Findings
233(3)
Pathophysiology
236(1)
Surgical Strategy
237(5)
Suture Annuloplasty
238(1)
Ring Annuloplasty
239(1)
Edge-to-Edge Repair
239(1)
Leaflet Extension
240(1)
Chordal Replacement
240(1)
Tricuspid Valve Replacement
241(1)
Surgical Technique
242(1)
Post-operative Echocardiogram
243(1)
Comment
244(1)
Recommended Reading
244(3)
17 Tricuspid Valve Infective Endocarditis
247(10)
Case History
247(1)
Echocardiographical Findings
247(1)
Pathophysiology
247(2)
Surgical Strategy
249(5)
Leaflet Reconstruction
250(2)
Bicuspidisation Annuloplasty (Posterior Leaflet Exclusion)
252(1)
Down-Sizing Annuloplasty
252(1)
Tricuspid Valve Replacement
253(1)
Intravenous Drug Abuse
253(1)
Surgical Technique
254(1)
Post-operative Echocardiogram
255(1)
Comment
256(1)
Recommended Reading
256(1)
18 Atrial Fibrillation Surgery
257(20)
Case History
257(1)
Pathophysiology
257(1)
Surgical Strategy
258(13)
Cox-Maze III
259(1)
Alternative Energy Sources
259(1)
Radiofrequency Ablation
260(1)
Cryoablation
261(1)
Lesion Sets
262(3)
Pulmonary Vein Isolation
265(2)
Left Atrial Appendage
267(3)
Post-operative Management
270(1)
Surgical Technique
271(4)
Comment
275(1)
Recommended Reading
275(2)
Index 277
Narain Moorjani is a cardiothoracic surgeon providing the full range of cardiac surgical procedures, including coronary artery bypass grafting and aortic valve replacement.  He forms part of the specialist valve group, performing complex mitral valve repair surgery, as well as surgery of the thoracic aorta. He also performs procedures to control abnormal heart rhythms, as well as minimally invasive cardiac surgery (including valve surgery through small incisions and coronary surgery without the use of the heart-lung bypass machine). He was the first surgeon to introduce minimally invasive cardiopulmonary bypass to Papworth Hospital.





Narain Moorjani came to Papworth having previously worked as a consultant cardiac surgeon at the Royal Brompton Hospital, London and Assistant Professor in Cardiothoracic Surgery in Philadelphia, USA. Prior to that, he completed a research doctorate of medicine (MD) at the University of Oxford and National Heart and Lung Institute, investigating the genes involved in the development of heart failure. His research interests are currently focussing on the genes responsible for enlargement of the thoracic aorta.

Dr. Bushra S. Rana  was appointed as a consultant cardiologist and clinical lead in diagnostic and interventional echocardiography and cardiac testing (non-invasive) at Papworth Hospital in 2009. She is currently the Co-Lead in specialist valve and structural heart disease service and co-chair in the trans-aortic valve implantation (TAVI) programme at Papworth Hospital. She is also an active member of the British Society of Echocardiography (BSE) and a committee member since 2005 and the Chair of Education Committee since 2013. Dr Rana has also developed national training programmes such as the BSE Advanced Imaging Conference, that is held yearly at the Royal society of Medicine, London.







Francis C. Wells is a recognized leader in the field of mitral and tricuspid valve surgery.  He lectures on the subject internationally and has published numerous articles on the topic. He initially trained in London and the United States, before moving to Papworth Hospital as a consultant cardiothoracic surgeon in 1986. His specialist area of cardiac surgical interest is the management of all forms of heart valve disease, especially mitral valve reconstruction.

Mr Wells has the largest experience in the United Kingdom and among the largest in the world with over 3,000 cases completed achieving a near 100% repair rate for leaking mitral valves with mortality at less than 1.0% for first time procedures. His aim is to achieve a normally functioning valve. He also has an interest in aortic valve repair and surgery of the aorta. In his thoracic practice, Mr Wells offers a full range of surgical procedures for lung cancer and all benign diseases in the chest. This includes hyperhydrosis, thoracic outlet syndrome and pectus deformities.