Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

• DOI: 10.1186/s13019-021-01626-4
• Publication Date: 2021-08-26T10:03:55Z
• Authors: Aditya Eranki; Claudia Villanueva; Nicholas Collins; Peng Seah
• Keywords: Male; RD1-811; Coronary artery bypass grafting; Case Report; Thrombosis; Aortic Valve Stenosis; Coronary Artery Disease; Cardiac surgery; Valvular heart surgery; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Anesthesiology; Aortic Valve; Humans; Surgery; RD78.3-87.3; Coronary Artery Bypass; Left ventricular thrombus; Video assisted surgery

Abstract 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.