In recent years much attention has been paid to a minimal invasive surgery even in the field of cardiac surgery. We have successfully treated a 59 year-old male who underwent transaortic video-assisted thrombectomy in the left ventricular cavity following acute myocardial infarction due to occlusion (No. 7) of the left descending coronary artery (LAD). After the LAD was recanalized by percutaneous transluminal coronary angioplasty (PTCA) and then stenting, this thrombectomy was carried out. Following initiation of cardiopulmonary support, thrombus in the left ventricular apex was safely removed by transaortic endoscopic guidance. This technique was useful especially for the patient with poor ventricular function due to acute myocardial infarction because of no left ventriculotomy. Endoscopic guidance technique is reported in detail.