Endoscopic MICS Excision of a Left Ventricular Glomus Tumor

Primary cardiac tumors have a very low prevalence. The most common cardiac tumor is myxoma, while the most common left ventricle (LV) mass is thrombus. The most common LV tumors are rhabdomyoma or fibroma (1). Glomus tumor or glomangioma of the left ventricle has been described but is very rare (2). The authors present a patient with a left ventricular glomus tumor who underwent endoscopic excision of the tumor. The patient was a 41-year-old-female who was incidentally diagnosed with a left ventricle (LV) tumor. Echocardiography showed a well-pedunculated, freely mobile tumor measuring 1.1 x 0.9 cm attached to the LV apex. Hence, she was scheduled for endoscopy-assisted minimally invasive LV tumor excision. 

The patient was positioned supine with her arms tucked alongside her body. Femora-femoral peripheral cannulation was performed to establish cardiopulmonary bypass. A 5 cm incision was made in the right fourth intercostal space to serve as the main working port. A camera port was placed in the third intercostal space along the anterior axillary line. An additional incision was made at the second intercostal space for the placement of the Chitwood clamp. 

Following pericardiotomy, the space behind the ascending aorta and above the right pulmonary artery was dissected to accommodate the Chitwood clamp. The interatrial groove was dissected, and the left atrial incision site was marked. The aorta was cross-clamped and antegrade cardioplegia was administered through the aortic root. The left atrium was opened, and an endoscope was passed into the left ventricle through the mitral valve orifice and the LV was inspected. The tumor was found attached to the LV apex near the posteromedial papillary muscle with a well-defined stalk. The tumor, along with its stalk, was excised, and a thorough wash was given. The LV was inspected, and the left atrium (LA) was closed. Deairing was performed through the root vent, the LV was massaged, and the aorta was declamped. Once the rhythm returned, the patient was weaned off cardiopulmonary bypass uneventfully and decannulated. Hemostasis was secured, and the pericardium was reapproximated to complete the procedure. A drain was placed and brought out along the camera port. 

The patient's postoperative course was uneventful. She stayed in the intensive care unit (ICU) for one day and was discharged home on postoperative day five. This case highlights the reproducibility and ease of access for deep-seated LV tumors using an endoscopic approach. 

References

1. Dinesh Kumar US, Shetty SP, Sujay KR, Wali M. Left ventricular mass: A tumor or a thrombus diagnostic dilemma. Ann Card Anaesth. 2016 Oct-Dec;19(4):728-732. doi: 10.4103/0971-9784.191551. PMID: 27716707; PMCID: PMC5070336.
2. Ferrera, Carlos et al. Left ventricular glomangioma. International Journal of Cardiology, Volume 160, Issue 3, e38 - e39.

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