Why the study?
LV thrombus complicates acute myocardial infarction and causes systemic thromboembolism, prompting the need for alternative surgical removal techniques during concurrent cardiac surgery.
A transaortic video-assisted approach offers a viable, tissue-sparing technique for left ventricular thrombus removal during concurrent aortic valve and coronary surgery.
Trans-aortic endoscopic LV thrombus removal during surgery appears feasible; hypothesis-generating and requires prospective validation before wider use.
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.
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Eranki et al. (2021) studied this question.
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