Cardiac tumors and gastroendoscopy: endoscopic resection of left ventricular tumors.

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 tumormediated 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. 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 (▶Video1). 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. 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. E-Videos