1;Contents;6 2;Preface;10 3;1 Introduction;12 3.1;1.1 General thoughts on endoscopic surgery;12 3.1.1;1.1.1 The philosophy;12 3.1.1.1;The ideas behind it;12 3.1.1.2;Complexity;13 3.1.1.3;Experience;13 3.1.1.4;Valve repair - frequency of valve replacements;14 3.1.2;1.1.2 The team;14 3.1.3;1.1.3 Holding out;15 3.2;1.2 How to start an endoscopic program;16 3.2.1;1.2.1 Starting conditions for endoscopic mitral valve surgery;17 3.2.2;1.2.2 Patient-related arguments;18 3.2.2.1;Prognosis;18 3.2.2.2;Need for blood transfusion;20 3.2.2.3;Wound-healing disturbances;20 3.2.2.4;Cosmetic reason;21 3.2.3;1.2.3 Hospital-related arguments;22 3.2.3.1;Marketing;22 3.2.3.2;Economic reasons;22 3.2.4;1.2.4 Patient selection;24 3.2.5;1.2.5 Teaching course;26 3.2.6;1.2.6 Starter kit for endoscopic mitral valve surgery;26 3.2.7;1.2.7 Overview;27 4;2 Anesthesiology and pain management;30 4.1;2.1 Intubation and ventilation;30 4.2;2.2 Pain management;30 5;3 Technical prerequisites;34 5.1;3.1 Cannulas and extracorporeal circulation;34 5.1.1;3.1.1 Arterial cannulas (retrograde perfusion);34 5.1.2;3.1.2 Arterial cannulas (antegrade perfusion);35 5.1.3;3.1.3 Venous cannulas;36 5.1.4;3.1.4 Extracorporeal circulation;39 5.2;3.2 Accessories;39 5.2.1;3.2.1 Soft-tissue retractor;39 5.2.2;3.2.2 Arms for videoscopic camera and atrial retractor;40 5.3;3.3 Instruments;41 5.3.1;3.3.1 Atrial hook;44 5.4;3.4 Sutures;44 6;4 Preparations;48 6.1;4.1 Arterial and venous cannulation;48 6.1.1;4.1.1 Femoral vessel cannulation after preparation;48 6.1.2;4.1.2 Direct cannulation of the ascending aorta;51 6.2;4.2 Mini-thoracotomy;54 6.3;4.3 Ports;58 6.4;4.4 Videoscopy;59 6.4.1;4.4.1 The wrinkle;60 6.4.2;4.4.2 The diameter;61 6.4.3;4.4.3 The monitor picture;61 6.4.4;4.4.4 Additional helpful details;61 6.5;4.5 Cardioplegia;62 6.5.1;4.5.1 Use of cardioplegia;62 6.5.2;4.5.2 Operations under fibrillation;66 6.6;4.6 Aortic clamping;67 6.6.1;4.6.1 Endoclamping;67 6.6.2;4.6.2 The Chitwood technique;68 6.6.3;4.6.3 Complications;70 7;5 Valve repair techniques;72 7.1;5.1 Quadrangular resection;72 7.1.1;5.1.1 Pathological anatomy;72 7.1.2;5.1.2 Theoretical remarks;73 7.1.3;5.1.3 Practical realization;73 7.1.3.1;Identifying the prolapse;73 7.1.3.2;Cutting out of the prolapse;74 7.1.3.3;Narrowing of the annulus;76 7.1.3.4;Closure of the gap;77 7.2;5.2 Triangular resection;79 7.2.1;5.2.1 Pathological anatomy;79 7.2.2;5.2.2 Theoretical remarks;80 7.2.3;5.2.3 Practical realization;80 7.2.3.1;Identifying the prolapse;80 7.2.3.2;Cutting out the prolapse;81 7.2.3.3;Narrowing of the annulus;81 7.2.3.4;Closure of the gap;82 7.3;5.3 Sliding technique;82 7.3.1;5.3.1 Pathological anatomy;82 7.3.2;5.3.2 Theoretical remarks;83 7.3.3;5.3.3 Practical realization;84 7.3.3.1;Identifying the diseased parts;84 7.3.3.2;Cutting out of diseased part(s);85 7.3.3.3;Retiring the leaflet;87 7.3.3.4;Narrowing of the annulus;88 7.3.3.5;Sliding and refixation;88 7.4;5.4 Neochords - preformed loops;89 7.4.1;5.4.1 Pathological anatomy;90 7.4.2;5.4.2 Theoretical remarks;92 7.4.3;5.4.3 Practical realization;94 7.4.3.1;Identifying the diseased parts;94 7.4.3.2;Measurement of the chordae length;94 7.4.3.3;Implantation of preformed loops;96 7.5;5.5 Neochords - flexible length;96 7.5.1;5.5.1 Pathological anatomy;97 7.5.2;5.5.2 Theoretical remarks;97 7.5.3;5.5.3 Practical realization;98 7.5.3.1;Identifying the diseased parts;98 7.5.3.2;Measurement of the chorda length;98 7.5.3.3;Implantation of flexible chords;98 7.6;5.6 Artificial rings;102 7.6.1;5.6.1 Theoretical remarks;102 7.6.2;5.6.2 Implantation technique;103 7.6.3;5.6.3 Complications;105 7.7;5.7 Emergency exit;106 7.7.1;5.7.1 Theoretical remarks;106 7.7.2;5.7.2 Practical performing;107 8;6 Tips and tricks;110 8.1;6.1 Perfusion's challenge;110 8.2;6.2 Diaphragm's obesity;111 8.3;6.3 View's hurdles;112 8.4;6.4 Instruments' versatility;114 8.5;6.5 The knot pusher's independent existence;117 8.6;6.6 Managing bleeding;120 8.6.1;6.6.1 Bleeding of ascending aorta;120 8.6.2;6.6.2