Totally Thoracoscopic Mitral Valve Replacement In An Adolescent Patient: First Clinical Experience
Mukhamedov Ikromzhon, Joshybaev S.D., Alibekov A.A., Rozbaev Z.N., Kenbaev A.B., Zelentsova A.A., Ukolova Y.N.

Scientific and Clinical Center of Cardiac Surgery and Transplantology, Taraz, Kazakhstan

BACKGROUND

Totallythoracoscopicmitralvalvereplacementinadolescentsrepresentsapromisingdirectionincardiacsurgery,combiningminimalinvasiveness,highclinicalefficacy,andrapidpostoperativerecovery.Thisapproachisparticularlyrelevantinadolescentpatientsduetoanatomicalandphysiologicalcharacteristics,aswellasthesignificantcosmeticbenefits.Wepresentourfirstclinicalexperienceoftotallythoracoscopicmitralvalvereplacementperformedthroughthreeports.

METHODS

A16-year oldfemalepatient(height152cm,weight48kg)wasdiagnosedwithcongenitalheartdisease,mitralvalveprolapse,andseveremitralregurgitation(gradeIII).Thepatientpresentedwithdyspneaonminimalexertion,palpitations,andgeneralweakness.Themedicalhistoryincludedrecurrentinfectionsandprogressivemitralregurgitationsince2017.Theoperationwasperformedundercardiopulmonarybypassusingperipheralcannulationofthefemoralarteryandveinandtherightinternaljugularvein.MyocardialprotectionwasachievedwithantegradeDelNidocardioplegia.Atotallythoracoscopicright-sidedapproachusingthreeportswasapplied,withtransthoracicaorticcross-clamping.Surgicalstepsincludedmitralvalveinspection,resectionoftheaffectedleaflets,andimplantationofamechanicalMedInzh28prosthesiswithpreservationoftheposteriorleaflet.Themitralvalvewasaccessedthroughtheleftatrium.Intraoperativeassessmentwasperformedusingtransesophagealechocardiography.

RESULTS

Theprocedurewascompletedsuccessfullywithoutintraoperativeorin-hospitalmortalityandwithoutneurologicalcomplications.Cardiopulmonarybypasstimewas180minutes,aorticcross-clamptimewas140minutes.Durationofmechanicalventilationwas175minutes,intensivecareunitstaywas15hours,andtotalpostoperativehospitalstaywas7days.Transthoracicechocardiographypriortodischargedemonstratedsatisfactoryprostheticvalvefunction

CONCLUSIONS

Totallythoracoscopicmitralvalvereplacementinadolescentsisafeasibleandsafetechnique.Furtherexperienceandlong-termfollow-uparerequired