Cardioscopy: potential applications and benefit in cardiac surgery

Objective: Cardioscopy in open heart surgery is still not routine in most u nits. However, since our first report in 1996 we use this device more frequ ently, because we think that safety and accuracy of different surgical proc edures is increased. Methods: Between 1/96 and 12/97 we performed cardiosco py in 100 patients. Indications (IND) for cardioscopy were as follows: IND (1) resection of hypertrophied septum (N = 15); IND (2) evaluation of aorti c valve with low grade stenosis or insufficiency (N = 12); IND (3) removal of intracardiac foreign bodies/tumors (N = 13); IND (4) inspection of VSD p rior and after repair (N = 8); IND (5) identification of paravalvular leaka ge (N = 8); IND (6) diagnostic purposes (N = 4); IND (7) education of surge ons and operating room staff (N = 40). During cardioplegic arrest the 5 mm rigid or flexible cardioscope (Storz(R), Tuttlingen, Germany) was inserted through ascending aorta, aortic valve or tricuspid valve depending on indic ation. Results: No complication occurred during cardioscopy. IND (1): there was an excellent view of all intracardiac structures. Thorough resection o f hypertrophied septum was possible and there was no injury of adjacent str uctures or aortic valve. IND (2): all valves were inspected through a 1 cm aortic incision and the pathology of the valves was documented. In case of severe calcification, the valve was replaced although transvalvular gradien t was less than 50 mm Hg. IND (3): intraventricular foreign bodies, such as felt pledges (N = 2), debris (N = 5), thrombi (N = 4) and tumors (N = 2) w ere entirely removed through the aortic valve with a special forceps. IND ( 4): anatomy of VSD was documented in all cases. It was possible to test acc uracy of all patch-sutures. IND (5): all paravalvular leakages were identif ied eventhough there was heavy immobility of the mechanical valve. IND (6): a papillary muscle (N = 2) and a thrombus formation (N = 2) were diagnosed . IND (7): the surgeons and operating room staff could follow the entire pr ocedure in all cases. Conclusions: Cardioscopy is a supporting technique to clearly identify intracardiac structures, to control several surgical proc edures, to document valve pathology, and to educate surgeons and operating room staff. Handling is easy and does not increase operative risk. Some pro cedures will be performed with minimal invasivity in future. (C) 1999 Elsev ier Science B.V. All rights reserved.