Ann Thorac Surg 1996;62:1845-1846
© 1996 The Society of Thoracic Surgeons
Case Report
Diagnostic Transaortic Cardioscopy of the Left Ventricle
Erwin P. Bauer, MD,
Oliver T. Reuthebuch, MD,
Matthias Roth, MD,
Wolf-Peter Klövekorn, MD
Division of Cardiothoracic Surgery, Kerckhoff Clinic of the Max Planck Institute, Bad Nauheim, Germany
Accepted for publication June 16, 1996.
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Abstract
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Preoperative diagnosis of pathologic intracardiac structures by noninvasive techniques is sometimes difficult or even impossible. In these cases a heart operation is required with opening of one or more cardiac chambers. We demonstrate direct visualization of the left ventricular cavity by transaortic cardioscopy in a patient with a pathologic intraventricular structure. With this technique we could avoid ventriculotomy.
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Introduction
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Video-assisted minimally invasive endoscopic operations have been performed with increasing frequency during the last decade. This method reduces surgical trauma significantly in most cases. Up to now, there are few publications dealing with video-assisted cardioscopy [–5]. We describe the technique of video-assisted cardioscopy in a patient with coronary artery disease and a pathologic intraventricular structure (Fig 1
). Preoperative diagnosis was not possible by ventriculography or by transesophageal echocardiography in this case.
The heart was exposed through a median sternotomy, and the patient was put on cardiopulmonary bypass after takedown of the left internal mammary artery. A vent was inserted through the left upper pulmonary vein into the ventricle. The aorta was cross-clamped, and cold blood cardioplegia was infused by antegrade and retrograde route. Coronary artery bypass grafting was performed as usual. After completion of the distal anastomoses a 5-mm hole was punched into the ascending aorta at the site of the forthcoming proximal anastomoses. The cardioscope consisted of a 4-mm rigid 30-degree optical system attached to a xenon light source. A one-chip camera was connected to the cardioscope (Storz Endoscopy, Tuttlingen, Germany). The signal was transmitted to a screen and a video recorder. All of the equipment was placed opposite the surgeon. The cardioscope was inserted into the punched aortic hole. The aortic valve was focused, and the device was passed through the center of the valve (Fig 2). It was then possible to thoroughly explore the entire ventricular cavity. In the region of the apex a severely hypertrophied papillary muscle was identified, which the cardiologist declared to be a pathologic structure preoperatively (Fig 3). The cardioscope was drawn back. After rewarming, the aorta was declamped and one proximal venous anastomosis was performed at the site where the cardioscope was primarily inserted. The operation was completed as usual. The additional ischemic time for the cardioscopic procedure was 7.4 minutes.
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Fig 3. . Cardioscopic view of the apex of the left ventricle. The hypertrophied papillary muscle is marked with arrows. The vent, inserted through the right upper pulmonary vein and the mitral valve, is encircled with a dotted line.
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Comment
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Up to now, endoscopy is not a standard method in cardiac surgery. There are only few reports dealing with cardioscopy. Minato and Itoh [2, 3] examined tricuspid valve function in dogs with a fiberoptic cardioscope. Burke and associates [4] described application of cardioscopy in congenital heart disease. Furuse and colleagues [5] examined function of an aortic valve intraoperatively, whereas Legget and Shaw [6] described inspection of the right ventricle with a cardioscope. Up to now, we have applied cardioscopy in the following situations: examination of valve function before reconstruction and after repair, resection of hypertrophied ventricular septum, assessment of entry and reentry in aortic arch dissection, and removal of intracardiac foreign bodies. Cardioscopy was carried out without complication in all cases. Ventriculotomy was redundant in several patients, and the duration of the aortic cross-clamp time was insignificantly prolonged.
In conclusion, cardioscopy is a method that can be applied as an adjunct during open heart operations. There are several possible indications, and use of the cardioscope may increase in the future.
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Footnotes
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Address reprint requests to Dr Bauer, Division of Cardiothoracic Surgery, Kerckhoff Clinic of the Max Planck Institute, D-61231 Bad Nauheim, Germany (e-mail: Erwin.P.Bauer{at}Kerckhoff.med.uni-giessen.de).
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References
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- Uchida Y, Tomaru T, Nakamura F, Oshima T, Fujimori Y, Hirose J. Percutaneous fiberoptic cardioscopy of the left ventricle. Jpn Heart J 1991;32:455–71.[Medline]
- Minato N, Itoh T. Direct imaging of the tricuspid valve annular motions by fiberoptic cardioscopy in dogs. I. Does De Vega's annuloplasty preserve the annular motions? J Thorac Cardiovasc Surg 1992;104:1545–53.[Abstract]
- Minato N, Itoh T. Direct imaging of the tricuspid valve annular motions by fiberoptic cardioscopy in dogs with tricuspid regurgitation. II. Does flexible ring annuloplasty preserve the annular motions? J Thorac Cardiovasc Surg 1992;104:1554–60.[Abstract]
- Burke RP, Michielon G, Wernovsky G. Video-assisted cardioscopy in congenital heart operations. Ann Thorac Surg 1994;58:864–8.[Abstract/Free Full Text]
- Furuse A, Kohno T, Ohtsuka T. Intraoperative visualization of the aortic valve from the left ventricle. J Thorac Cardiovasc Surg 1995;109:395.
- Legget ME, Shaw DP. Fiberoptic cardioscopy under cardiopulmonary bypass: potential for cardioscopic surgery? Ann Thorac Surg 1994;58:222–5.[Abstract/Free Full Text]
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Abstract
Introduction
