Endoscopic techniques have expanded in recent years and now have the potential to
be useful not only in digestive diseases but also in diseases usually seen by other
departments. Cardiac tumors require surgical resection to prevent tumor-mediated embolism
[1]; however, a left ventriculotomy significantly decreases the ejection fraction [2].
We previously reported two cases of cardiac surgery using rigid scopes [3], but in this case a gastroendoscope was used. The patient was a 73-year-old woman
who was diagnosed with a cerebral infarct. Echocardiography detected a mobile mass
([Fig. 1]), and she was referred to the Department of Cardiovascular Surgery. We decided to
use an endoscope to prevent a decrease in ejection fraction; however, the space to
perform the procedure was expected to be narrow and would have been insufficient if
a rigid scope had been inserted. Therefore, we used a gastroendoscope, which allowed
the insertion of devices through the scope.
Fig. 1 Echocardiographic image showing a mobile mass measuring 1.5 cm in diameter, suggestive
of a tumor arising from the ventricular septum of the left ventricle.
The procedure was performed via a median full sternotomy and the ascending aorta was
opened. The gastroendoscope was inserted into the heart through the aortic valve.
The cavity was narrow and the procedure using a rigid scope might have been difficult.
The tumor was joined to three chordae tendineae ([Fig. 2]), which we divided using hot biopsy forceps ([Video 1]). The tumor was resected without complications and echocardiography revealed no
change in the patient’s ejection fraction (before, 71 %; after, 72 %). Histological
examination revealed a papillary fibroelastoma.
Fig. 2 Endoscopic views of the tumor showing: a the tumor positioned close to the aortic valve, meaning the space for the procedure
was expected to be narrow; b the tumor combined with the ventricular septum by chordae tendineae.
Video 1: The procedure was performed via a median full sternotomy and the ascending
aorta was opened. We used a gastroendoscope to resect the tumor with hot biopsy forceps.
We removed the tumor with the scope to prevent specimen loss.
In general, bleeding is a severe adverse event associated with gastrointestinal endoscopic
resection [4]. This procedure is however not associated with a risk of bleeding as, even if bleeding
is extensive, the blood remains in the systemic circulation.
This is the world’s first report of the insertion of a gastroendoscope into the heart.
Cardiac tumors and a gastroendoscope would appear to be an amazing combination, and
this approach may offer exciting new possibilities for the application of endoscopic
techniques.
Endoscopy_UCTN_Code_TTT_1AO_2AN
