A. Alotaibi1, G. A. Al-Dossari1, P. T. Roughneen1 1University Of Texas Medical Branch,Cardiovascular And Thoracic Surgery,Galveston, TX, USA
Introduction: Currently, cardiologists and cardiac surgeons visualize intracardiac anatomy through the echocardiography and cardiac catheterization or by open-heart surgery. The concept of cardioscopy, or endoscopy of the heart, dates back to the early 20th century with the first cardioscope developed by Drs. Rhea and Walker in 1913. The first published article was in 1922 by Drs. Allen and Graham. Since then, several attempts have been made to design the ideal cardioscope. Cardioscopy, however, has not advanced as rapidly as other forms of endoscopic surgery because of problems with visualization through blood within the beating heart. We present a novel endoscopic technique in performing a direct visualization of intracardiac anatomy in a porcine heart utilizing carbon dioxide (CO2) and normal saline (NS), and we describe its use as a diagnostic and therapeutic treatment to advance the future of the cardiovascular disease.
Methods: Our model involves cardioscope access in a porcine heart and great vessels with the use of CO2 and NS. During the first trial in 2016, a flexible endoscopy machine was used to visualize intracardiac anatomy. We expanded our work in 2017 and present the data herein. Purse strings were applied on both the right heart side (right atrium and pulmonary artery) and left heart side (aorta and left atrium). The pulmonary veins, the superior vena cava, and the inferior vena cava were closed with 3-0 Prolene sutures to allow the heart to fill with the NS and CO2. A flexible Olympus bronchoscope was used. This endoscope has outside diameters of approximately 5-6 mm, with an ability to flex 180 degrees and extend 120 degrees. The endoscope was inserted through the harvested porcine aortic artery, and CO2 was utilized to inflate the heart.
Results: We were able to view intracardiac structure through different heart axis views (the left and right heart axes). However, despite rotation and flexion of the 180-degree endoscope, it was not possible to see the mitral valve; although, other areas in the left ventricle were visualized.
Conclusion: Cardioscopy has potential as a diagnostic and therapeutic technique. However, the design of a cardioscope should include 360 degrees of rotational capacity and a side arm, the capability for therapeutic intervention, and improved optic visualization through blood utilizing digital subtraction technology.