Resection of Fibroelastoma in Left Ventricular Outflow Tract by Minimally Invasive Approach

This video demonstrates the resection of a fibroelastoma in the left ventricular outflow tract using a minimally invasive approach. The 83-year-old female patient was asymptomatic. Her cardiovascular history included a stent for infrarenal aortic aneurysm. Computed tomography angiography showed no lesions. The transesophageal echocardiography showed a hyperechoic mobile image that protruded towards the left ventricular outflow tract, impacted the noncoronary valve, and was attached to the septum by a small pedicle. Mild aortic insufficiency was also noted. The ejection fraction was conserved (66%).

The authors approached the procedure through a ministernotomy, with a vertical sternum incision made 8 to 10 cm from the third intercostal space. The arterial cannulation for cardiopulmonary bypass (CPB) is preferably done via the ministernotomy. An alternative cannulation site is the femoral artery, although it is not without complications. The venous cannulation was inserted into the femoral vein, with a long cannula that reached the right atrium. In this way a total CPB was obtained. CPB time was 42 min and aortic cross-clamp time was 32 min. After clamping and opening the aorta, cardioplegia was administered via the coronary ostia. The tumor was resected and the aortic closure was performed. After weaning from CPB, the cannulas were removed and the sternotomy was closed in the standard fashion. The patient was extubated in the operating room and she remained in the intensive care unit for 24 hours.

The patient’s postoperative course was satisfactory, without transfusion or inotropic drugs. She was discharged on the fourth postoperative day.