Left ventricular thrombi is mostly seen in patients
with complicated myocardial infarction. Cardiac
surgery morbidity and mortality risk increases in
patients who have had COVID-19 infection in the
perioperative period. Postponing the cardiac surgery
for COVID-19-infected patients was advised if
possible.[
2] Our patient had a history COVID-19 a
month before surgery, and the real-time polymerase
chain reaction was negative preoperatively.
The presence of LV thrombi is associated with a risk
of systemic embolization. The results of conservative
treatment for mobile and pedunculated LV thrombi are
poor compared to surgical treatment.[3] The mobility of
an LV thrombus and history of cerebral embolism were
strong indications for urgent cardiac surgery.
Surgical treatment is mostly performed by LV
aneurysmectomy if there is an aneurysm. However, if
there is no LV aneurysm, ventriculotomy may cause
severe complications, such as severe arrhythmias,
depressed myocardial contractility, and bleeding. A
lot of new intracardiac thrombi case reports related to
COVID-19 infection were recently published,[4-6] and
it was remarkable that most of these cases did not form
an LV aneurysm.[7]
In our case, the patient had no LV aneurysm but
a mobile pedunculated thrombus in the LV apex
and moderate to severe mitral valve regurgitation
with noncritic coronary artery stenosis. Video-assisted
cardioscopy was previously reported in a cardiac tumor
and a thrombus excision.[8,9]
Left atriotomy could be a choice for the LV
approach, but mitral chordal structure and fragility
of the thrombus may not allow to reach and remove the thrombus safely. Cardioscopy could be done
through the left atriotomy as a transmitral approach.
Unfortunately, our camera body was rigid and straight,
the chest was deep, and the handle of the camera
was not flexible. Transaortic approach is another
choice. Therefore, we reached the inside of the left
ventricle by the gentle retraction of aortic leaflets,
and an endoscopic camera facilitated a view of the
deep part of the LV cavity. All thrombus parts were
removed safely, and the LV cavity was visualized by an
endoscopic camera and irrigated by saline. Mitral ring
annuloplasty was performed, and the operation was
completed without any complications.
In conclusion, transaortic cardioscopy facilitates
LV thrombectomy and avoids ventriculotomy. This is
practical for removing a mobile or pedunculated LV
thrombus in the absence of an LV aneurysm.
Patient Consent for Publication: A written informed
consent was obtained from patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea, concet, design, control/
supervision, data collection and processing, analysis, literature
review, writing the article, review, references, materials:
M.B.A.; Idea, data collection, literature review: B.U.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.