Left Atrial Thrombectomy Under Cardiopulmonary Bypass Without Aortic Cross-Clamping Using Rapid Ventricular Overdrive Pacing: A Case Report.
Tomohide Takei, Takeshi Nagaoka, Hitoshi Sato
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Case in brief
A 73-year-old woman with a history of valve replacement presented for evaluation of elevated C-reactive protein levels. Imaging revealed a large non-mobile mass in the left atrium, which persisted despite anticoagulation. Due to significant adhesions around the aortic root, traditional surgical approaches were deemed risky. Instead, left atrial thrombectomy was performed under cardiopulmonary bypass without aortic cross-clamping, utilizing rapid ventricular overdrive pacing. The procedure was successful, and the patient recovered well.
What made this case unusual
The use of rapid ventricular overdrive pacing to achieve temporary circulatory arrest during left atrial thrombectomy without aortic cross-clamping is an atypical approach that may reduce surgical risks in high-risk patients.
Diagnostic / clinical pearl
Clinicians should consider rapid ventricular overdrive pacing as a viable alternative for achieving circulatory arrest in patients with significant surgical risks due to adhesions or prior surgeries.
Why it matters
This case highlights an innovative surgical technique that may improve outcomes in patients requiring complex cardiac procedures, particularly those with challenging anatomical considerations.