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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tomislav Mihaljevic Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mihaljevic, T. Search for Related Content PubMed Articles by Mihaljevic, T. Related Collections Related Article

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Correspondence

Reply

Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195

(Email: mihaljt{at}ccf.org).

To the Editor:

We thank Dr Inoue [1] for his thoughtful comments on our article [2]. However, we have a completely different view of the subject. Beating heart cardioscopy, as proposed by Inoue [1] uses a balloon-tipped flexible cardioscope. This approach allows very limited visualization of intracardiac anatomy because the instrument needs to be pressed against the structure that needs to be visualized. Use of adjunctive visualization techniques (such as echocardiography) has proved to be very difficult due to poor image quality caused by echogenicity of instrumentation. Therefore, the use of this technology has been limited to the repair of simpler defects and creation of ablation lines for atrial fibrillation [3, 4]. However, the use of such instruments for treatment of valvular heart disease is close to impossible because they distort the valve anatomy and can cause the obstruction of blood flow or severe regurgitation. Although the idea of balloon-tipped cardioscopes is very old, it never established itself in clinical practice due to the previously mentioned limitations.

In contrast, our method provides a stable hemodynamic environment and unlimited visualization of the entire intracardiac anatomy, which is the essential prerequisite for successful complex intracardiac interventions [2]. We do not believe that cannulas for extracorporeal circulation limit the use of instruments because they can be designed in such a way that allow simultaneous delivery of instrumentation.

In conclusion, we believe that efforts in the development of methods for intracardiac visualization are important. Whether those methods will be used with or without cardiopulmonary bypass will likely depend on the indication for treatment.

	References

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1. Inoue Y. Beating heart cardioscopy: on-pump or off-pump?(letter) Ann Thorac Surg 2008;86:1401.[Free Full Text]
2. Mihaljevic T, Ootaki Y, Roberson JO, et al. Beating heart cardioscopy: a platform for real-time, intracardiac imaging Ann Thorac Surg 2008;85:1061-1066.[Abstract/Free Full Text]
3. Inoue Y, Yozu R, Mitsumaru A, Ueda T, Kawada S. Video-assisted cardioscopic stable closure for atrial septal defect Artif Organs 1997;21:1303-1305.[Medline]
4. Inoue Y, Yozu R, Onogurchi K, Kabei N, Takeuchi S, Kawada S. Caridioscopic guidance of linear lesion creation for radiofrequency ablation Ann Thorac Surg 2003;75:1189-1193.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tomislav Mihaljevic Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mihaljevic, T. Search for Related Content PubMed Articles by Mihaljevic, T. Related Collections Related Article