International Society For Minimally Invasive Cardiothoracic Surgery

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Left Ventricular Apical Fibroelastoma Excised By Minimally Invasive Approach
Bilal H. Kirmani, FRCS (CTh), Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.

OBJECTIVE: A 71 year old female presenting with a cerebrovascular accident was found to have a mass in her left ventricular apex. The patient had a history of bilateral breast cancers treated with wide local excision and radiotherapy. Cross-sectional imaging was performed to distinguish between thrombus and tumour and 18-FDG PET scan showed low uptake in the mass with no other primary or secondary lesions. We undertook diagnostic and therapeutic surgery via a right mini-thoracotomy and demonstrate the exposure and access here.
METHODS: The patient underwent minimally invasive excision through a right mini-thoracotomy with femoral cannulation for bypass. There were dense pleural and pericardial adhesions, presumed to be related to her previous radiation therapy. An intra-aortic occlusion device was used to cross-clamp and deliver cardioplegia. The left ventricle was entered via the left atrium and mitral valve, with excellent exposure.
RESULTS: An indiscrete lesion with gelatinous consistency and a typical sea-anemone was removed. Histology confirmed a completely excised benign fibroelastoma. The patient was discharged home uneventfully after 6 days and has had no further recurrence of symptoms.
CONCLUSIONS: We demonstrate here the feasibility of left ventricular apical procedures through the right mini-thoracotomy.


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