右小開胸完全鏡視下による経左房的/経僧帽弁的アプローチで摘出した急性心筋梗塞後左室内血栓の1例

Totally Endoscopic Trans-atrial and Trans-mitral Removal of a Left Ventricular Thrombus through Right Minimally Invasive Thoracotomy in a Patient with Acute Myocardial Infarction：Report of a Case

はじめに　左室内血栓は心筋梗塞後の合併症として比較的多く，外科的治療に関してはアプローチ法を含め手術方法に多数の報告例がある．われわれは右小開胸完全鏡視下による経左房的/僧帽弁的アプローチで心筋梗塞後左室内血栓除去術を施行した1例を経験したので，文献的考察を加え報告する．

A 49-year-old man was diagnosed with acute myocardial infarction and underwent percutaneous coronary intervention （PCI） for complete left anterior descending artery （LAD） occlusion. Two weeks later, transthoracic echocardiography revealed a mobile left ventricular thrombus. Due to its increasing size despite anticoagulation therapy, he was transferred to our department. Emergency surgery was performed using a totally endoscopic trans-atrial and trans-mitral approach through a right minimally invasive thoracotomy. The thrombus was completely removed under direct endoscopic visualization without the need for left ventricular incision. The postoperative course was uneventful, and no residual thrombus was observed. This minimally invasive approach is considered safe and effective for selected patients.