Excision Of A Papillary Fibroelastoma Originating From The Pulmonary Valve Via Left Anterior Thoracotomy: A Case Report
ali ihsan hasde, mustafa bahadır inan, çağdaş baran, evren özçınar, mehmet çakıcı, ahmet rüçhan akar, kemalettin uçanok.
ankara university school of medicine department of cardiovascular surgery, ankara, Turkey.
OBJECTIVE: Although benign cardiac tumors do not metastasize, they should be removed surgically when diagnosed, to prevent thromboembolic events, stroke and heart failure due to obstruction. Cardiac tumors mainly excised via a sternotomy or a right thoracotomy under cardio-pulmonary by-pass with cross clamping.
METHODS: A 51 years old asymptomatic woman with a cardiac mass originating from the pulmonary valve admitted to our department for surgical excision. Transoesophagial echocardiography demonstrated a 1x1.4 cm immobile, oval shaped mass attached to the pulmonary valve leaflets. Computerized tomographic examination was performed to evaluate the mass but also the positon of the pulmonary artery and right ventricular out flow tract compared to the sternum.
RESULTS: The mass was excised through a left anterior thoracotomy on cardiopulmonary bypass via femoral cannulation (Figure 1, 2). Arteriotomy was performed 2cm above the pulmonary valve on beating heart. The mass which was later diagnosed as fibroelastoma histologically was originating from one of the leaflets of the pulmonary valves.
CONCLUSIONS: Left anterior thoracotomy provide a good and safe exposure for right ventricule and the pulmonary artery when cardiac arrest is not needed. Saving sternotomy in these patients has many advantages due to minimally invasive approach, and keeping the sternotomy option for potential future cardiac diseases.
Figure 1: Left anterior thoracotomy
Figure 2: Exposure of pulmonary artery and papillary fibroelastoma
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