PMC9280099_01
(a) Sessile mass in the left ventricular apex. (b) Mobile mass attached by a pedunculated portion to a broad base
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F1
Echocardiography demonstrated moderate tricuspid and mild mitral valve regurgitation, normal coronary artery dimensions, severely reduced left ventricular (LV) ejection fraction (31%), and a sessile mass in the LV apex [Figure 1a and Video 1, online]. As LV function improved, the mass appeared increasingly mobile and more pedunculated [Figure 1b and Video 2, online] increasing the risk of embolization.
(a) Left ventriculotomy used to access the mass. (b) Mass following complete resection. (c) Ventriculotomy closure using felt strips
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F2
As LV function improved, the mass appeared increasingly mobile and more pedunculated [Figure 1b and Video 2, online] increasing the risk of embolization. A fish-mouth incision was made 2-3 cm lateral and parallel to the left anterior descending artery [Figure 2a]. The thrombus measured 1.9 cm x 1.5 cm x 0.6 cm and was completely excised [Figure 2b]. A series of felt strips were employed to assist in the closure of the left ventriculotomy, which was performed in two layers with a running 5-0 polypropylene suture [Figure 2c].