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Published on: September 9, 2020
Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report
Aditya Eranki1, Claudia Villanueva2, Nicholas Collins2
1John Hunter Hospital, Newcastle, Australia. adit.eranki@gmail.com.
Insights
This study presents a novel trans-aortic endoscopic technique for left ventricular (LV) thrombus removal during concurrent cardiac surgeries. This minimally invasive approach preserves LV function by avoiding damage to surrounding tissues.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Thrombosis Management
Background:
- Left ventricular (LV) thrombus formation is a serious complication following acute myocardial infarction, increasing the risk of systemic thromboembolism.
- Traditional surgical approaches for LV thrombus removal can be invasive and may compromise myocardial function.
Observation:
- A 47-year-old male with a mobile LV thrombus, bicispid aortic valve, and coronary artery disease underwent surgical intervention.
- A trans-aortic endoscopic approach using videoscopy and specialized instrumentation was employed for thrombus extraction.
Findings:
- The transaortic video-assisted technique allowed for excellent visualization of the LV apex.
- Near-complete removal of the LV thrombus was achieved with minimal disruption to the surrounding trabeculae.
- The patient subsequently underwent successful aortic valve replacement and coronary artery bypass grafting.
Implications:
- This alternative technique offers a less invasive method for LV thrombus removal, potentially preserving cardiac function.
- The described approach may be beneficial for patients requiring concurrent cardiac surgeries.
- Further research could explore the long-term outcomes and broader applicability of this endoscopic technique.
Introduction:
Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement.
Case Presentation:
A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting.
Conclusion:
We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.
