Endoscopic Transmitral Thrombectomy for Left Ventricular Thrombus

Abstract

Left ventricular (LV) thrombosis is a potentially life-threatening complication in patients with severely impaired LV function, particularly after myocardial infarction or dilated cardiomyopathy. Although anticoagulation treatment remains the first-line treatment approach, surgical thrombectomy is indicated for patients with large, mobile, or refractory thrombi. We present a case-based review of 4 patients who underwent endoscopic transmitral LV thrombectomy via right thoracotomy. This surgical technique allowed precise thrombus removal without ventriculotomy; all patients demonstrated favorable recovery with no major perioperative complications. A structured literature review was also conducted to compare the transmitral, transaortic, and transventricular approaches. In 1 case, no thrombus was identified intraoperatively, highlighting the importance of intraoperative imaging. In conclusion, our findings suggest that endoscopic transmitral thrombectomy is a feasible and safe option, offering reduced myocardial trauma and shorter recovery times in selected patients. This review contributes to the growing body of evidence supporting minimally invasive strategies for LV thrombosis management.

Keywords: beating-heart surgery; endoscopic cardiac surgery; left ventricular thrombus; minimally invasive surgery; thrombectomy.