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Cardioscope: A New Innovation for Visualization of Intracardiac Pathology

Amal Alotaibi, Ghannam Al Dossari and Patrick T Roughneen

Background: Since the conception of cardioscopy in the early 20th century, several attempts have been made to design the ideal cardioscope. We present a novel endoscopic technique providing direct visualization of intracardiac anatomy in a porcine heart and describe the use of cardioscopy as a diagnostic and therapeutic treatment to advance the treatment of cardiovascular disease.

Materials and Methods: Our model involves cardioscope access in a porcine heart utilizing carbon dioxide and normal saline, using a flexible endoscopy to visualize intracardiac anatomy. Purse strings were applied on both the right (right atrium and pulmonary artery) and left (aorta and left atrium) sides. The pulmonary veins, superior vena cava, and inferior vena cava were closed with 3-0 prolene sutures allowing the heart to fill with the normal saline and carbon dioxide. A flexible Olympus (Center Valley, PA, USA) bronchoscope was used, measuring approximately 5-6 mm in outside diameter, with the ability to flex 180 degrees and extend 120 degrees. The endoscope was inserted through the harvested porcine aorta and atrium, and carbon dioxide was utilized to inflate the heart.

Results: Transaortic approach: we were able to view the aortic valve, coronary orifices, papillary muscles, mitral valve, and left ventricle. Right atrial approach: the right atrial, tricuspid valve, papillary muscle, pulmonary valve, and right ventricle were visualized.

Conclusions: Cardioscopy has potential as a diagnostic and therapeutic technique. However, the design of the cardioscope needs innovation, including 360 degrees of rotational capacity, capability for therapeutic intervention, and improved optic visualization through blood utilizing digital subtraction technology.