Patent RU-2644924-C1 (RU)
Inventor: BOKERIYA LEONID ANTONOVICH
IPC: A61B18/02
Filed: 2017-06-09
Granted: 2018-02-14
Abstract: FIELD: medicine. 
     SUBSTANCE: ablation is performed in the right and left atria, isolating the left atrial appendage, together with annuloplasty of tricuspid and mitral valves. The right atrium is opened by a longitudinal incision along the atrioventricular sulcus. With cryoablation, the zone of "typical" atrial flutter is isolated. The cryoisolation line is located between the two edges of the right atrial incision and is directed anterior to the base of the inferior vena cava and posterior to the coronary sinus. Then the zone of "atypical" atrial flutter is isolated, for which the cryoisolation line is first directed between two cuts of the right atrium in the proximal segment of this atrium, then along the base of the right atrial appendage, the base of the superior vena cava and is ended above the upper edge of the upper right pulmonary vein. Access to the left heart (left atrium) is provided and cryoablation is performed: a line is applied along the back flap of the mitral valve, retreating 7-10 mm from it, from the left fibrous triangle to the lower edge of the interatrial septum incision; the following line is applied, isolating the right pulmonary veins, for this purpose the proximal part of a cryoprobe is set in the zone of the distal segment of the first cryoablation line and the line is continued along the inner surface of the atrium 7-10 mm proximally to the mouths of these pulmonary veins with an exit to the left atrial incision; then a cryoablation line is made from the left atrial incision from the left side of the aortic root 7-10 mm proximally to the mouths of the left pulmonary veins and to the proximal segment of the first cryoablation line. The left atrial appendage is completely screwed into the left atrium and is cryo-isolated, covering the entire base of the left atrial appendage with transition of the cryoablation line to the zone corresponding to the proximal segment of the coronary sinus. Tricuspid valve annuloplasty is performed, for which the first suture is applied at the base of the septal valve flap above the level of the medial edge of the coronary sinus, moving along the valve ring clockwise in a circle to the lateral edge of the coronary sinus. Gaskets are installed on the first and last stitches, then the first needle is used to carry out a part of the second suture in a counter-clockwise direction to the commissure level between the back and front flaps. The annuloplasty is finished with the second needle, the same way as the first row counterclockwise to the location of the first needle. The suture is tied on a metal dilator. Mitral valve annuloplasty is performed, for which the first needle suture begins over the anterior valve of the mitral valve at a distance of 3-5 mm from the medial commissure and directed clockwise along the valve ring above the rear flap with an exit to the 3-5 mm within the front flap. On the first and last stitches, gaskets are set, then the same needle is used to create a suture the opposite direction, retreating 1.5-2 mm from the previous line, along the back flap of the mitral valve, the second needle completes the second suture line distally to the location of the first needle, a gasket is installed. The left atrial appendage is bandaged. The interatrial cut is sutured layer wise. Right atrium integrity is restored. Right ventricle and left ventricle deaeration is performed successively with restoration of blood circulation. 
     EFFECT: method allows simultaneous isolation of the foci of trigger activity and sources of macroretrirous circles formation in the atria, preventing the redistribution of fibrotic rings of atrioventricular valves, thereby minimizing the risk of repeated valve dysfunction, atrial fibrillation and development of atrial flutter. 
     1 ex, 3 dwg