ventriculotomy

Ventriculotomy is a surgical procedure that involves making an incision into the wall of a ventricle of the heart, most commonly the left ventricle but also performed on the right ventricle when access to intracavitary structures is required. The procedure is typically performed under cardiopulmonary bypass with the heart temporarily stopped or arrested, allowing the surgeon to open the ventricular cavity and treat pathology or to obtain access for repair.

Indications include resection or biopsy of intracavitary tumors or masses, removal of thrombi, resection of scar tissue or aneurysm within the ventricle, and access for repair of congenital defects or complex valvular procedures where intraventricular visualization is necessary. It may also be used to place devices or perform intraventricular ablation/diagnostic mapping in selected cases. The procedure is chosen when direct access to intraventricular structures is essential for the operation.

Technique notes: the incision location depends on access needs; common sites include the anterior wall of the left ventricle or the right ventricular free wall. After the procedure, the ventricle is closed with sutures or patches, and normal cardiac function is restored. Myocardial protection and cooling are used to minimize ischemic injury.

Risks and complications include bleeding, myocardial damage, arrhythmias, heart block, ventricular dysfunction, perforation, air embolism, infection, and thromboembolism. There is also a risk of long-term scar formation affecting contraction or causing arrhythmias.

Prognosis and alternatives: outcomes depend on the underlying disease and the success of the intervention; ventriculotomy can provide essential access or symptom relief but carries significant surgical risk. Alternatives include percutaneous or minimally invasive techniques when feasible, or nonoperative management for certain conditions. (Not to be confused with ventriculostomy, a distinct neurosurgical procedure.)