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Eur J Cardiothorac Surg 2001;19:152-155
© 2001 Elsevier Science NL

Cardiopulmonary endoscopy: an effective and low risk method of examining the cardiopulmonary system during cardiac surgery

Cardiothoracic Centre, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK

Received 2 August 2000; received in revised form 3 November 2000; accepted 15 November 2000.

Corresponding author. Tel: +44-1482-623256; fax: +44-1482-623257
e-mail: ARJCALE{at}aol.com

Objectives: During cardiac surgery it is sometimes necessary to examine heart chambers remote from the site of surgery. Similarly visualization of the pulmonary arterial tree will enable assessment for the completeness of pulmonary embolectomy. There are no standard adjunctive procedures to accomplish this. Left ventriculotomy used to examine the left ventricle, and maneuvers used to ensure complete pulmonary embolectomy can have serious complications. Impelled by the need to obviate the complications, we adopted and, herein describe a simple method of examining the cardiopulmonary system with an endoscope. Our early experience is also presented. Method: Transmitral cardioscopy was performed in two patients, and pulmonary angioscopy in one. One patient had the combined procedure. The indications for transmitral cardioscopy were; suspected left ventricular thrombus and a right atrial thrrombus propagating into the left atrium through a patent foramen ovale. The indications for pulmonary angioscopy were pulmonary embolectomy and right atrial thrombus. Surgical technique: Cardiopulmonary endoscopy was performed on cardiopulmonary bypass, at an appropriate stage of the primary procedure. For transmitral cardioscopy, a flexible fibreoptic endoscope was passed into the left ventricle through the right superior pulmonary vein, or the right atrium. For pulmonary endoscopy, the flexible endoscope was introduced through a pulmonary arteriotomy. At the end of the procedure, the port of entry of the endoscope was closed and cardiopulmonary bypass terminated. Results: A good visualization of the cardiac chambers and the pulmonary artery was obtained in all the patients. One patient was found to have an endocardial scarring, and a left ventricular thrombus was excluded in another. Visual guidance facilitated pulmonary emboli retrieval. There were no complications in these patients. Conclusion: Cardiopulmonary endoscopy is simple, safe and effective in examining the cardiac chambers and the pulmonary arterial system. It can be performed with a sterilized flexible fibreoptic endoscope. It facilitates pulmonary embolectomy, and precludes procedures and maneuvers that can cause serious complications. It adds a visual advantage to pulmonary embolectomy, which is otherwise blind. Cardiopulmonary endoscopy has the potential for a wider applicability, possibly in minimally invasive and robotic cardiac surgery.

Key Words: Transmitral cardioscopy • Pulmonary angioscopy • Cardiopulmonary endoscopy

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