Giant Left Atrial Myxoma Resection

In this video, the authors present the surgical resection of a left atrial myxoma. The patient was an 84-year-old woman who was admitted at a regional hospital for recent onset of effort dyspnea (NYHA functional class 3). A cardiac ultrasound showed a left atrial mass prolapsing in the left ventricle. She was then transferred to the authors’ center where a transesophageal echocardiography confirmed the diagnosis with a stenosis on the mitral flow (mean transvalvular gradient of 12 mm Hg). A coronary angiography did not reveal any significant stenosis and the patient was scheduled for surgical resection. The operation was performed through a median sternotomy. After longitudinal pericardiotomy, the cardiopulmonary bypass was instituted by cannulation of the ascending aorta and superior and inferior vena cava. The aorta was cross-clamped and antegrade Del Nido cardioplegia was delivered in the aortic root.

The right atrium was opened and stay sutures were used to facilitate atrial septum exposure. Through the incision of the fossa ovalis, the mass insertion to the interatrial septum was identified and a traction suture was applied. By means of careful dissection, the atrial myxoma was removed and the zone of attachment excised. During the entire open heart surgery, carbon dioxide was delivered in the operative field.

The tumor appeared as a voluminous mass of about 6 cm in length with a gelatinous apparence; on its surface, yellowish and hemorrhagic areas were present. The presence of additional tumors was excluded after removing a little remnant, and the left atrium was irrigated with saline solution. The endocardium was sutured directly with no need of pericardial patch, and the septum was closed. In this case, the interatrial approach was feasible because of the tumor connection towards the anterior mitral annulus. Otherwise, a biatrial access could be the alternative choice. After a proper deairing of the left chambers, the aortic clamp was removed and the right atrium closed.

Intraoperative echocardiography demonstrated only a mild residual mitral regurgitation. The operation was completed in the usual manner. The istopathologic examination confirmed the diagnosis of atrial myxoma. The patient was discharged at home in the seventh postoperative day.

References

1. Buyukates M, Aktunc E. Giant left atrial myxoma causing mitral valve obstruction and pulmonary hypertension. Can J Surg. 2008 Aug; 51(4): E97–E98.
2. Shimizu Y, Itoda Y, Higashikuni Y, Kadowaki Y, Saito A, Fujita H, et al. Giant left atrial myxoma that caused mitral valve obstruction and pulmonary hypertension. Int J Cardiol. 2015 Nov 15;199:38-39.
3. Pujol-López M, San Antonio R, Flores-Umanzor EJ, Guasch E, Azqueta M. A rare cause of severe mitral stenosis and reversible pulmonary hypertension. Echocardiography. 2017 Oct;34(10):1544-1545.

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