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The authors present a case of a minimally invasive left atrial myxoma resection performed via a biatrial approach with an inverted T-incision (1).
The patient was a 73-year-old woman presenting with exertional dyspnea, fatigue, and dizziness. Transthoracic echocardiography revealed a large left atrial mass measuring 40 × 33 mm, left atrial enlargement (40 mm), and mild mitral regurgitation. Preoperative whole-body computed tomography (CT) angiography was performed to plan the minimally invasive approach, and coronary angiography demonstrated no significant coronary lesions.
The operation was carried out through a right transaxillary approach in the third intercostal space (2). A transthoracic aortic cross-clamp was applied, and cardioplegia was delivered via the aortic root. After cardiac arrest and left atriotomy, an additional right atrial incision was made, creating an inverted T-shaped biatrial approach to optimize exposure. The mass was excised, and the resultant atrial septal defect was repaired with an autologous pericardial patch. After aortic unclamping, sinus rhythm was restored spontaneously. Intraoperative transesophageal echocardiography confirmed complete excision, no residual septal defect, and mild mitral regurgitation.
The postoperative course was uneventful. The patient spent one day in the intensive care unit and was discharged home on postoperative day five.
References
- Yüksel A, Saba D, Velioğlu Y, Ener S, Özkan H. Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas. Brazilian Journal of Cardiovascular Surgery [Internet]. 2016; Available from: http://dx.doi.org/10.5935/1678-9741.20160066
- Waghefi T, ŽIvković I, Petrov A, Alexiou K, Kappert U, Matschke K, et al. Transaxillary Access for Minimally Invasive Surgery for Benign Primary Cardiac Tumors. 53rd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) [Internet]. 2024 Jan; Available from: http://dx.doi.org/10.1055/s-0044-1780702
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