Paul Modi, Ansar Hassan, Carolyn J. Teng, Evelio Rodriguez, Walter Randolph Chitwood, Jr.
East Carolina Heart Institute, East Carolina University, Greenville, NC, USA.
OBJECTIVE: Left ventricular (LV) myxomas are extremely rare, accounting for 2.5-4% of all myxomas. Surgical resection is indicated to prevent embolism or intracardiac obstruction. Our video demonstrates the set-up and technique for minimally invasive (MI) endoscopic transaortic resection of these tumors .
METHODS: A 65 year old asymptomatic male undergoing work-up for a cardiac murmur was incidentally discovered to have a 12mm LV myxoma attached to the lateral ventricular wall at the junction of the middle and distal thirds. Surgical approach was through a 5cm right anterior 2nd intercostal thoracotomy without resection of costal cartilage. Peripheral cardiopulmonary bypass (CPB) with vacuum-assisted venous drainage and systemic hypothermia (26°C) was used. The aorta was clamped transthoracically and myocardial protection achieved with antegrade cardioplegia. A 5mm videoscope was introduced through the 2nd intercostal space and used to visualise the interior of the LV cavity. Long-shafted instruments were used to resect the tumor.
RESULTS: Excellent visualisation was achieved. The cross-clamp time was 50 mins and CPB time was 66 mins. Intra-operative echo confirmed complete resection. Inotropes were not used, the patient was extubated after 5 hours, spent 24 hours on the ICU and discharged in 5 days. Histology confirmed myxoma with clear resection margins.
CONCLUSIONS: Minimally invasive endoscopic resection of LV tumors, even at the apex, is feasible and can be performed safely. Long term follow-up is needed.
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