Transaortic Direct Visualization Of The Left Ventricle Endocardium During Cabg: The Final Word In Diagnostic Contradictions
Egor Malyshenko, Vadim Popov, Magomed Gasangusenov, Semen Petko, Maxim Novikov, Amiran Revishvili.
A.V. Vishnevskiy National research center of surgery, Moscow, Russian Federation.
BACKGROUND:Nowadays there is still no method for determining left ventricular thrombosis with 100% specificity and sensitivity. The transaortic direct endoscopic visualization of the left ventricle endocardium during CABG is the approach of direct minimally invasive visualization of LV cavity by inserting a 5mm 0̊ camera through the ostia in the ascending aorta which usually used for proximal anastomosis during CABG. It helps to eliminate diagnostic and tactical faults in the treatment of such patients.
METHODS:The prospective study included 30 patients with small left ventricular aneurysm, in whom ventriculoplasty was inappropriate, since the area of the scar after reconstruction would exceed the area of the aneurysm. In the preoperative period, a TEE, СT-scan and MRI were performed. However, no precise information was obtained on the presence of thrombosis in the preoperative period. All patients underwent transaortic direct endoscopic visualization of the left ventricle endocardium (through the ostia in ascending aorta for proximal anastomosis the 5mm 0̊ camera was inserted into the LV cavity). In 7 patients (23.3%) LV thrombosis was detected, which was not detected by other methods. In 6 patients (20%) the thrombosis was confirmed by TEE, 17 patients (56.6%) had an intact ventricular cavity.
RESULTS:In all patients with detected thrombosis the thrombus was removed and ventriculoplasty was performed. CPB-time increased by an average of 7 + 4 min and was 77 + 13 min, aortic cross-clamping time was 49.8 + 8 min. Blood loss was 500 + 120 ml, ICU-stay was 1 day. Patients didn’t have bleeding and resternotomy. There were no thromboembolic events during 12 postop month.
CONCLUSIONS:Transaortic direct endoscopic visualization of the left ventricle endocardium during CABG is the safe and effective approach which completely solves the challenge of discrepancies between indirect LV imaging data (cardiac CT scan, MRI or TEE). It allows in 100% of cases to exclude or to confirm even the smallest thrombi in LV, to avoid unnecessary ventriculotomy and reduce the incidence of thromboembolic complications.
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