Asian Cardiovasc Thorac Ann 2008;16:510-511
© 2008 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Transaortic Video-assisted Excision of a Left Ventricular Mass
Jun Kawamoto, MD,
Koshiro Ishibashi, MD,
Takanori Shibukawa, MD,
Hironori Izutani, MD
Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, Hiroshima, Japan
For reprint information contact: Hironori Izutani, MD Tel: 81 823 22 3111 Fax: 81 823 21 0478 Email: h-izutani{at}rgmc.izumisano.osaka.jp, Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima 737-0023, Japan.
A 44-year-old man was found to have a left ventricular mass by transthoracic echocardiography. He had multiple events of systemic embolization for last few years. Transthoracic echocardiography revealed a mobile heterogeneous mass in the left ventricular cavity attached to the lateral free wall with a short stalk (Figure 1
). The heart was not dilated and the heart function was normal. There was no ventricular wall motion abnormality. The findings suggested left ventricular myxoma or thrombus. Surgical excision was recommended to avoid further embolization. A median sternotomy was made and standard cardiopulmonary bypass was accomplished. An ascending aortic cross-clamp was placed and cardioplegic cardiac arrest was achieved. A transverse aortotomy was performed and the aortic valve was exposed. Transvalvular inspection of the left ventricular cavity did not demonstrate the mass under direct vision. A 30 degree 10mm endoscope (Olympus, Tokyo, Japan) was inserted into the left ventricle through the aortotomy. A left ventricular mass was visualized by endoscopy (Figure 2A). An articulating endoscopic grasper (U.S. Surgical, Norwalk, CT) was inserted through the aortotomy along the endoscope. The mass was pulled and removed by the grasper under endoscopic visualization.
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Figure 1. Transthoracic echocardiography showing a mobile heterogeneous left ventricular mass attached to the lateral free wall with a short stalk.
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Figure 2. Transaortic endoscopic images showing a left ventricular mass (A) and a stalk which was grasped and excised by endoscopic instruments (B). G = grasper, M = mass, S = stalk, SS = scissors
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The mass was detached from a stalk arising from the endocardial wall. The stalk was excised including a margin of ventricular muscle using endoscopic grasper and scissors (Figure 2B
). The jaws of the articulating endoscopic instruments could be positioned in any plane for superior access to areas impossible to reach with straight endoscopic instruments through the aortotomy. The mass was resected totally endoscopically without left ventriculotomy. Postoperatively he underwent coronary angiograms which showed normal coronary arteries. Pathologically the excised mass was not a cardiac tumor. It was an organized thrombus with a fibrous stalk connected to endocardium. We performed surgical removal of the mass including the stalk as a cardiac tumor. Transaortic video-assisted endoscopic procedure was feasible and efficacy for left ventricular mass excision by commonly used endoscopic instruments under satisfactory magnified visualization.
