Intraoperative Endoscopic Resection of Left Ventricular Tumors

Abstract

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.

A systematic review of left ventricular cardio-endoscopic surgery

“…This was followed by semi-rigid endoscopes in four [7, 9, 21, 29], flexible endoscopes in three [2, 3, 30] and mixture of rigid and flexible endoscopes in one study [11]. In 13 studies, the type of endoscope used was not specified [4, 6, 10, 15, 20, 24–28, 31, 34, 35].…”

“…In 13 studies, the type of endoscope used was not specified [4, 6, 10, 15, 20, 24–28, 31, 34, 35]. Other adjunct endoscopic instruments such as forceps, graspers, scissors, suckers or retractors were used in 13 studies [2, 3, 12, 13, 15, 19, 21, 25, 30, 32, 34, 35, 37]. In the remaining it was not clear whether open surgical or endoscopic instruments were used.…”

“…Further examination of this case revealed that the patient was in fact suffering from palpitations prior to the operation with preoperative ECG finding of multiple atrial ectopics [32]. A successful outcome, defined as complete excision of the lesion, was achieved in all cases (100%, 50/50) among 30 studies reporting this outcome [2–15, 19, 21–28, 30–35, 37]. …”

Intraoperative bronchoscopic resection of a papillary fibroelastoma in the left ventricular outflow tract after aortic mechanical valve replacement

“…3 Misumi et al reported two cases of endoscopic resection of left ventricular tumors through the mitral valve and the aortic valve. 4 Li et al reported a technique using video-assisted cardioscopy to remove a left ventricular myxoma. [5][6][7] When the tumors are located on the valve surface, it is not diffi cult to perform a resection.…”

Video‐assisted endoscopic resection of left ventricular papillary fibroelastoma through the aortic valve

“…Some groups have performed direct resection of the tumor under endoscopic visualization using a rigid‐type thoracoscope or mediastinoscope . Others have visualized and removed the tumor with a snare with a flexible endoscope or gastrointestinal fiberscope and avoided the use of a rigid type with a straight shaft because of its inflexibility and poor handling . In our case, we used a video‐assisted rigid endoscope with a flexible head.…”