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A successful resection of left ventricular tumor in an 82-year-old woman who had undergone coronary artery bypass grafting ten years ago is presented. In an attempt to make a procedure less invasive, we chose a trans-mitral endoscopic resection with minimum dissection because of reoperation on patient of advanced age. With the use of cardiopulmonary bypass and cardioplegic protection, the right side of left atrium was incised longitudinally. The endoscope was inserted in the ventricle via the mitral valve. A stalk of the tumor was cut by snare strangulation and the whole tumor was extracted endoscopically. The postoperative course was uneventful. To our best knowledge, this is the first report on endoscopic resection of the left ventricular tumor via a mitral valve. This method appear to be the choice in resecting the left ventricular tumor.

Operative TechniqueThe operation was performed via a median full sternotomy. Cardiopulmonary bypass was established with either bicaval or single right atrial cannulation and single arterial cannulation. While using cardioplegic protection, the left atrium or ascending aorta was opened. Under direct vision, the inside of the left ventricle was scarcely visible through the mitral or aortic valve. As a result, an endoscope (XQ240; Olympus, Tokyo, Japan) was inserted into the left ventricular cavity through the mitral or aortic valve. The endoscopic operator stood on the left side of the patient in order to manipulate the endoscope easily (Fig. 1). The endoscope provided an excellent view of the left ventricular cavity and a tumor (Fig. 2a). In our cases, the tumor was attached with a stalk to the left ventricular wall. If the tumor was located on the posterior wall, then visualization of the stalk was relatively difficult. In such cases, after filling the left ventricle with a nonconducting solution, for example, 5% d-sorbitol solution, the tumor thus began to float, allowing us to visualize the tumor. Next, the stalk was snared and cut with high-frequency surgery units (ERB ICC200, Tokyo, Japan) (Fig. 2b). The tumor was retrieved using biopsy forceps and then it was removed with the endoscope (Fig. 2c). A prompt histological examination showed the resected margin to be free of any neoplasm. If the resected area appears to be incomplete, then an additional resection can be performed by either endoscopy or a direct ventriculotomy. There were no complications associated with this technique. DiscussionThe technique described above was performed on two patients. The first was an 82-year-old asymptomatic woman who underwent coronary artery bypass grafting Abstract Two cases involving patients who underwent a successful endoscopic resection of a left ventricular tumor are presented herein. One was an 82-year-old woman with a left ventricular papillary fibroelastoma, who underwent previous coronary artery bypass grafting. In an attempt to make the procedure less invasive, we used an endoscope. With a full sternotomy, cardiopulmonary bypass, and cardioplegic protection, the endoscope was inserted into the left ventricular cavity through the mitral valve. The other patient was a 63-year-old man with left ventricular papillary fibroelastoma, in whom we performed an endoscopic transaortic resection. The endoscope provided an excellent view, and the tumors were easily extracted in both cases without any complications.

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