A Minimally Invasive Approach for Cardiac Hemangioma Resection in a Teenager
Steven Thornton1, Anna Hoover1, Joseph Nellis, MD2, Douglas Overbey, MD3, John Haney, MD3, Joseph Turek, MD3.
1Duke University School of Medicine, Durham, NC, USA, 2Duke University Department of Surgery, Durham, NC, USA, 3Duke University Department of Surgery, Division of Cardiothoracic Surgery, Durham, NC, USA.
BACKGROUND: Cardiac hemangiomas are a rare primary cardiac tumor that are traditionally resected via median sternotomy. Since 2018, we have been using a 5cm left anterior mini-incision (LAMI) to perform procedures of the right ventricular outflow tract (RVOT) and pulmonary valve. Here we present one of the first reported cases of minimally invasive cardiac hemangioma resection and the first by left anterior mini-incision (LAMI). METHODS: An otherwise healthy 15 year old male presented with a symptomatic 3 cm cardiac hemangioma emanating from the right atrium and compressing the right ventricular outflow tract (RVOT). A 5 cm incision into the left 3rd intercostal space was made to expose the RVOT and peripheral femoral-femoral cardiopulmonary bypass (CPB) was initiated. The tumor was carefully enucleated with electrocautery and a visible margin was achieved. Following excision, the resulting RVOT defect was repaired with a Gore-Tex patch and running 4-0 prolene suture. The patient was weaned from CPB without difficulty. RESULTS: The operative time was 243 minutes with a cardiopulmonary bypass time of 55 minutes. The operation was without complication. Postoperative transesophageal echocardiogram demonstrated no extrinsic RVOT compression, no pulmonary insufficiency, and preservation of biventricular function. The patient’s chest tube was removed on postoperative day 1, and he was discharged without issue on postoperative day 2. Final pathology was consistent with vascular hemangioma. He was asymptomatic at his most recent follow-up and is active without restrictions. CONCLUSIONS: Cardiac hemangiomas are traditionally resected via median sternotomy. Here we demonstrate a new minimally invasive approach to cardiac hemangioma resection, the left anterior mini-incision (LAMI), which offered good visualization and comparable outcomes to sternotomy while avoiding sternal precautions and a larger central scar.
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