Mitral Detachment For Robotic Resection Of Ventricular Fibroelastoma
Elena Sandoval, MD FEBCTS1, Robert Pruna-Guillen, MD1, Andrea Beatriz De Lorenzi2, Daniel Pereda, MD PhD1.
1Hospital Clinic, Barcelona, Spain, 2Hospital General Granollers, Granollers, Spain.
BackgroundA 75-year-old male was referred to us with the diagnosis of left ventricular mass. Preoperative echocardiography confirmed the presence of a 3x2cm mass below the posterior mitral leaflet. A chest computed tomography discarded any additional lesions and the patient was scheduled for robotic tumor resection.
MethodsAt the OR, the right chest was slightly elevated and using single-lung ventilation the four robotic ports were placed as normally for robotic mitral surgery and the robotic platform docked. Cardiopulmonary bypass was started using femoral cannulation and a transthoracic clamp was used. Once the cardioplegia was administered the left atrium was opened and the ventricular aspect of the mitral valve explored. We confirmed the presence of a gelatinous 3x3cm mass attached to the ventricular wall. An initial attempt was made to expose the attachment of the mass without affecting the mitral valve, but was not possible since the pedicle was immediately underneath the posterior mitral leaflet. For this reason, we decided to detach the posterior mitral leaflet in order to obtain a better exposure. This allowed us to completely resect the mass with its pedicle. The posterior mitral leaflet was then reattached to the annulus using a double running polypropylene suture. After closing the left atrium, cardiopulmonary bypass was discontinued. Postoperative transesophageal echocardiography showed no residual tumoral mass and trivial mitral regurgitation.
ResultsThe patient recovered uneventfully and was discharged on the 4th postoperative day. The pathology study of the mass confirmed a papillary fibroelastoma.
ConclusionsRobotic resection of ventricular tumors is feasible using the same approach used for mitral surgery. It provides excellent exposure of both the atrium and the ventricle and allows to perform complex techniques involving the mitral valve if needed.
Back to 2022 Display Posters