Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

Abstract

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.

Left ventricular thrombus with extracorporeal membrane oxygenation: Novel technique of bronchoscope-guided thrombus retrieval

“…The practice of using a videoscope from within a cardiac chamber is termed “cardioscopy.” 3 Case reports as early as 1999 describe use of a straight videoscope (5-mm or 10-mm rigid scope). 4 , 5 With a redo sternotomy and dense adhesions, rigid instruments were not adequate in this case. A flexible bronchoscope allows 360° rotation, advantageous in a redo setting.…”

Acute Lymphocytic Myocarditis With Mobile Left Ventricular Thrombus

“…In addition, patients with acute myocarditis are younger, at a median age between 30 and 45 years [8], and the social impact of embolic complications is considerable. Surgical thrombectomy is one treatment option [9].…”