Minimally Invasive Approach for Excision of Giant Left Atrial Myxoma
Apollo Gleneagles Kolkata, Kolkata, India
Minimally invasive approach for excision of giant Left Atrial myxoma
Background : We present a rare case of a giant Left Atrial myxoma with rheumatic mitral regurgitation. LA myxoma excision with Mitral valve replacement was performed through a right anterior mini thoracotomy approach.
Methods :1. Incision : A 5cm right subareolar incision was made and the chest entered through the 4th intercostal space2. Cannulation : Right Internal Jugular vein cannulated percutaneously at the time of induction of anaesthesia. Femoral vessels exposed with a 2 cm transverse incision on right groin. Femoral artery and vein cannulated. Aorta crossclamped with a Chitwood clamp though the 2nd Intercostal space and heart arrested with antegrade root cardioplegia.3. Approach : LA opened posterior to the Sondergaard’s groove. Myxoma excised in pieces along with a part of Inter-atrial septum. The defect in the septum closed directly. Mitral valve replaced with a mechanical valve in a continuous suturing technique.
Results : The entire myxoma was excied with no residual tumour.
Conclusions : Minimally invasive approach to the Left Atrium gives a adequate exposure to the LA chamber, the Inter-atrial septum and the mitral valve. A giant LA myxoma(6x5cm) could be conveniently excised. Continuous suturing technique for mitral valve replacement is routinely practised in our unit in Minimally invasive approach.