Author + information
- Andrea Colli, MD, PhD∗ (, )
- Erica Manzan, MD,
- Fabio Zucchetta Fabio, MD,
- Cristiano Sarais, MD,
- Demetrio Pittarello, MD,
- Giovanni Speziali, MD and
- Gino Gerosa, MD
- ↵∗Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
Transapical beating-heart neochord (Neochord DS1000, Minnetonka, Minnesota) implantation to repair mitral valve regurgitation has been demonstrated to be a safe and effective minimally invasive alternative to open surgical repair in selected patients with mitral leaflet prolapse (flail/chordae rupture) (1–3). Successful neochord implantation depends on accurate localization of the site of regurgitation and efficient intraoperative communication between the echocardiographer and the surgeon. Two-dimensional (2D) and 3-dimensional (3D) transesophageal echocardiography (TEE) are mandatory to guide the surgeon during all phases of the procedure. We illustrate step-by-step the echocardiographic roadmap of the procedure using both 2D and 3D TEE. The additional value of 3D TEE lies mainly in the possibility of seeing the valve and the device in an anatomical context. For assessing mitral valve anatomy and guiding the device from the apex of the left ventricle across the mitral annulus, 2D TEE is preferred (Figs. 1A and 1B, Online Videos 1 and 2). Once the mitral valve has been crossed, the view is changed to real-time 3D TEE. 3D TEE allows for optimal orientation of the tip of the device with regards to the prolapsing segment of the leaflet (Fig. 1B). When appropriate positioning has been achieved, the jaws of the device are opened and the leaflet is grasped (Fig. 1C, Online Video 3). The GoreTex suture (W. L. Gore & Associates, Flagstaff, Arizona) is then deployed. The implanted neochord is easily visible on echocardiography (Fig. 1D, Online Video 4). Tension is applied on the GoreTex suture; if mitral regurgitation is effectively reduced, the neochordal position is considered to be good, and it is anchored to the apex of the heart. Depending on the operative result, additional neochords can be implanted by repeating the procedure to achieve maximal competence of the mitral valve (Fig. 1E, Online Videos 5 and 6).
For supplementary videos and their legends, please see the online version of this article.
Please note: Dr. Speziali is inventor of the Neochord device and Chief Medical Officer of NeoChord, Inc. All other authors have reported that they have no relationships relevant to this paper to disclose.
- American College of Cardiology Foundation
- ↵Seeburger J, Winkfein M, Hoebartner M, et al. Transapical neochord implantation. Multimedia Manual of Cardio-Thoracic Surgery. Available at: http://mmcts.oxfordjournals.org/content/2011/0420/mmcts.2010.004606.full. Accessed January 31, 2014.
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