Resection Of Left Atrial Myxoma Research Articles

Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon’s learning curve experience

ObjectivesTo evaluate the safety and efficacy of the port access approach for left atrial (LA) myxoma resection and to analyze the learning curve for this procedure. MethodsThirty-six consecutive patients with LA myxoma who underwent port access surgery between April 2018 and March 2023 were enrolled in this retrospective study. The procedure included (1) unilateral or bilateral femoral artery cannulation; (2) the use of three 5-mm trocars and a 20- to 30-mm port; (3) a transseptal, biatrial, or LA approach depending on the location of the tumor base; and (4) complete or subendocardial tumor resection. CUSUM analysis was used to evaluate the aortic cross-clamp (ACC) time and cardiopulmonary bypass (CPB) time learning curves. Variables among the learning curve phases were compared. ResultsThe average ACC and CPB times were 49 (range, 45-79) minutes and 127 (range, 120-164) minutes, respectively. There was 1 case of conversion to sternotomy due to aortic root bleeding and 1 case of unilateral pulmonary edema. CUSUMACCtime analysis included 3 phases: phase I, the initial learning period (cases 1-11); phase II, the technical competence period (cases 12-23); and phase III, the challenging period (cases 24-36). ConclusionsThe port access approach is safe and feasible for LA myxoma resection. According to the learning curve analysis, 11 cases are required to achieve technical competence, and 23 cases are required to address highly challenging cases.

Robotic Resection of Left Atrial Myxoma With Cryoablation of Tumor Stalk.

The purpose of this report is to demonstrate robotic cryoablation of an atrial myxoma stalk as a method to prevent recurrence and preserve atrial tissue. A 38-year-old female patient was taken to the operating room, and an atrial myxoma abutting the left inferior pulmonary vein was resected robotically. This was followed by cryoablation of the tumor stalk instead of a full-thickness resection to prevent an extensive reconstruction. The operation resulted in the successful resection of an atrial myxoma with minimal length of stay. Follow-up at 3 months has shown no evidence of residual or recurrent tumor. Follow-up at 1 year is planned. Cryoablation of an atrial myxoma stalk, when resection would require complex reconstruction, is a useful tool in the armamentarium of a minimally invasive cardiac surgeon.

Minimally Invasive Video-Assisted Thoracoscopic One-Stage Resection of Left Atrial Myxoma and Right Upper Lobectomy for Lung Cancer: Case Report

We report a case of a 74-year-old man with diagnosis of concomitant primary cardiac tumor and right upper lobe of lung cancer. Both tumors were evaluated to be resectable with no further metastasis. A one-stage resection of both tumors through right mini-thoracotomy with endoscopic assistance was performed. The cardiac tumor resection during cardiopulmonary bypass was performed first, followed by right upper lobectomy and lymph nodes dissection with the same incision and position. Short-term results were satisfying and previous literature was reviewed to evaluate this method.

Technical aspects of robotically assisted left atrial myxoma resection.

Technical aspects of robotically assisted left atrial myxoma resection.

Use of Carotid Embolic Protection Devices for Left Atrial Myxoma Resection in a Pediatric Patient

Use of Carotid Embolic Protection Devices for Left Atrial Myxoma Resection in a Pediatric Patient

Early result of minimally invasive left atrial myxoma resection at Cardiovascular Center - E hospital

Objectives: The study aimed to evaluate clinical and paraclinical characteristics of left atrial myxoma and the early result of minimally invasive left atrial myxoma resection at E hospital.
 Patients and methods: This is retrospective, descriptive study of consecutive patients, who underwent minimally invasive left atrial myxoma rejection, using total or video-assisted endoscopic technique from October 2016 to March 2021 at E hospital. There were 31 patients, consisting of 27 females and 04 males. The mean age was 53 ± 13 years old (range [17-74]).
 Results: Preoperative clinical manifestations were diverse. Asymptomatic form was in 3 patients (9.7%), hemodynamic symptoms were in 26 patients (83.9%), embolism were presented in 4 patients (12.9%), systemic symptoms were in 8 patients (25.8%). Anemia and elevated erythrocyte sedimentation rates were observed in 45.2% and 74.2%, respectively. Echocardiography results: the average tumor size was 4.2 ± 1.7 cm (range [1.7-8]), the site of attachment was mainly in the atrial septum (77.4%). Cardiopulmonary bypass time was 158 ± 43 minutes (range [100-252]), cross-clamp time was 84 ± 34.2 minutes (range [42-153]), ventilation time was 10,8 ± 7,0 hours (range [3-30]), intensive care unit stay was 1,5 ± 1,0 days (range [0.5-4]), and in-hospital stay was 9.5 ± 5.0 days (range [3-30]). There was no hospital mortality. Cerebrovascular accident was presented in one (3.2%), femoral artery stenosis was in one (3.2%), atrial fibrillation after surgery was in one(3.2%).There was no bleeding, that require reoperation, and no other serious complications.
 Conclusions: Initial results of left atrial myxoma resection, using minimally invasive total or video-assisted technique wassafe and effectivewith low complications, could be recommended toapply routinely in cardiac surgery centers.

Early result of minimally invasive left atrial myxoma resection at cardiovascular center - E hospital

Objectives: The study aimed to evaluate clinical and paraclinical characteristics of left atrial myxoma and the early result of the minimally invasive procedure to remove left atrial myxoma at E hospital.
 Subjects and methods: This is retrospective, descriptive study of consecutive patients, who underwent minimally invasive left atrial myxoma rejection, using total or video-assisted endoscopic technique from October 2016 to March 2021 at E hospital. There were 31 patients, consisting of 27 females and 04 males. The mean age was 53 ± 13 years old (from 17 to 74 years old)
 Results: Preoperative clinical manifestations were diverse. Asymptomatic form was in 3 patients (9.7%), hemodynamic symptoms were in 26 patients (83.9%), embolism symptoms were presented in 4 patients (12.9%), systemic symptoms (25.8. Anemia and elevated erythrocyte sedimentation rates were observed in 45.2% and 74.2%, respectively. Echocardiography results: the average tumor size was 4,8 ± 1,8 cm (from 1.7 to 8 cm), the site of attachment was mainly in the atrial septum (77.4%). Cardiopulmonary bypass time was 158 ± 43 minutes (from 100 to 252 minutes), cross-clamp time was 84 ± 34 minutes (from 42 to 153 minutes). Ventilation time was 10,8 ± 7,0 hours (from 3 to 30 hours), intensive care unit stay was 1,5 ± 1,0 days (from 0.5 to 4 days), and in-hospital stay was 9.5 ± 5.0 days (from 3 to 30 days). There was no hospital mortality. Cerebrovascular accident was presented in one (3.2%), femoral artery stenosis was in one (3.2%), atrial fibrillation after surgery was in one (3.2%). There was no bleeding, that require reoperation, and no other serious complications.
 Conclusions: Initial results of left atrial myxoma rejection, using minimally invasive total or video-assisted technique wassafe and effectivewith low complications, could be recommended to apply routinely in cardiac surgery centers

Left atrial myxoma resection through right mini-thoracotomy in a patient with retrosternal gastric tube.

We report a case with a retrosternal gastric tube after oesophagectomy, who required left atrial myxoma resection, pulmonary vein isolation and left atrial appendage closure. A right mini-thoracotomy approach was adopted to avoid neo-oesophagus injury, and nitric oxide inhalation was useful to facilitate one-lung ventilation while dissecting the pleural adhesion.

Diagnosis of Carney complex following multiple recurrent cardiac myxomas

Carney complex is a rare syndrome caused by a genetic mutation leading to multiple endocrine abnormalities and a variety of tumors. Here, we report a case of Carney complex diagnosed due to recurrent multiple myxomas in the right atrium of a patient 16 years after the resection of the primary left atrial myxoma. Surgical excision was performed for the multiple recurrent right atrial tumors under cardiopulmonary bypass. The patient remained complication-free after surgery and was discharged on the 14th day. He was scheduled to continue echocardiographic follow-up and periodic systemic review by an endocrinologist. This case emphasizes the fact that if cardiac myxomas tend to be multiple and recurrent at a relatively young age, the possibility of Carney complex should be considered, even in the absence of any other related feature other than cardiac tumors.

Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes.

Interatrial septal tachycardias (IAS-ATs) following atrial fibrillation (AF) ablation or cardiac surgery are rare, and their management is challenging. The purpose of this study was to investigate the electrophysiological features and outcomes associated with catheter ablation of IAS-AT. We screened 338 patients undergoing catheter ablation of ATs following AF ablation or cardiac surgery. Diagnosis of IAS-AT was based on activation mapping and analysis of response to atrial overdrive pacing. Twenty-nine patients (9%) had IAS-AT (cycle length [CL] 311 ± 104 ms); 16 (55%) had prior AF ablation procedures (median 3; range 1-5), 3 (10%) had prior surgical maze, and 12 (41%) had prior cardiac surgery (including atrial septal defect surgical repair in 5 and left atrial myxoma resection in 1). IAS substrate abnormalities were documented in all patients. Activation mapping always demonstrated a diffuse early IAS breakout with centrifugal biatrial activation, and atrial overdrive pacing showed a good postpacing interval (equal or within 25 ms of the AT CL) only at 1 or 2 anatomically opposite IAS sites in all cases. Ablation was acutely successful in 27 patients (93%) (from only the right IAS in 2, only the left IAS in 9, both IAS sides with sequential ablation in 13, and both IAS sides with bipolar ablation in 3). After median follow-up of 15 (6-52) months, 17 patients (59%) remained free from recurrent arrhythmias. IAS-ATs are rare and typically occur in patients with evidence of IAS substrate abnormalities and prior cardiac surgery. Catheter ablation can be challenging and may require sequential unipolar ablation or bipolar ablation.

Minimally Invasive Inframammary Approach to Left Atrial Myxoma Resection

Minimally invasive techniques for myxoma resection are rapidly becoming standard of care for such lesions. Inframammary incisions are commonly used in breast reconstruction. The use of this previous incision for myxoma resection is safe and serves as a cosmetically superior site for female patients. We describe a patient who underwent successful atrial myxoma resection through a previous breast augmentation inframammary incision.

P860 Multimodality imaging of multiple recurrent myxomas: the role of three dimensional echocardiography

Abstract A 33-year-old lady who underwent left atrial myxoma resection was found to have on a 3 years follow up transthoracic echocardiography (E) a multilobular mass in the right atrium. A 2D transesophageal echocardiogram (TEE) was performed. Two Multi-lobulated masses were seen in the right atrium(RA); one bigger attached by a peduncle to the atrial wall in between the interatrial septum (IAS) and the superior vena cava and one smaller attached to the inferior RA wall; a remnant likely a suture was seen on the right side of the fossa ovalis; another small mass was noted on the left atrial (LA) side of the IAS; a small mass attached close to the posteromedial commissure and P3 scallop of the mitral valve was also detected. The RA mass was partially protruding into the tricuspid valve during diastole with no significant obstruction to flow. Three dimensional TEE allows an anatomical imaging able to identify the peduncles of two right atrial masses and three LA masses that were confirmed at surgery and consistent with cardiac myxoma at histopathology : one close the previous resection area, one at the opening of the LAA (panel A, white arrow) and one close to the posterior commissure of mitral valve (panel B, yellow arrow) and that were not seen by 2D. Magnetic resonance imaging (MRI) with contrast identified and showed opacification of : two masses in the RA with the pedicles ; - one mass on the LA side of interatrial septum; - one mass close to mitral valve posterior commissure ; however it was not able to detect the small mass close to the LAA. In our case 2D Echocardiography and MRI were able to identify 4 of the 5 recurrences found at surgery. 3D TEE was the only technique able to identify all 5 lesions. MRI is considered the gold standard for detecting cardiac tumor masses; however, even after careful review, it was not possible to identify the presence of the mass close to LAA. In particular 3D TEE was able to image the left atrial masses by an "en face view" of the left atrium from above. In addition, the unique 2D planes in unconventional views allow a more clear identifications of the peduncles of the masses in the right atrium. The identification of the peduncles is mainstay for the diagnosis of recurrent myxomas and exclude other tumors like metastasis or sarcomas. In fact multiple recurrence are very rare in particular if we consider that are in the two atria. Genetic tests for Carney complex were negative. The MRI allowed to confirm the vascularization of the contrast and to identify the peduncles of two masses in the right atrium. A multimodality imaging is able to correctly detect recurrent myxomas by identifying the anatomical features and the vascularization and lead to the diagnosis ; 3DE was the only technique able to correctly identify all the recurrent myxomas and and its use has the potential for being considered the key adjunctive modality for the anatomy when advanced surgical plan is required. Abstract P860 Figure.

Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation

We report the case of a semi-urgent cardiac surgery, in a 19 gestation age pregnant. Despite the fact that the patient was asymptomatic, except for some palpitations, a large left auricle (LA) myxoma was fortuitously diagnosed with transthoracic echocardiography (TEE). Considering the important embolic risk, the tumor was successfully removed during cardiac surgery under cardiopulmonary bypass (CPB). Fetal bradycardia following defibrillation under stable maternal and CPB conditions was successfully managed. The postoperative period and remainder of the pregnancy was smooth and the delivery uneventful.

Left Atrial Malignant Fibrous Histiocytoma with Right Atrium Invasion.

Background:Primary cardiac tumors are rare (0.001 to 0.03%). Malignant tumors account for 25%, of which 75% are cardiac sarcomas.Case Persentation:Here, we report a case of a 57-year-old male with palpitation and history of left atrial (LA) myxoma resection presented to cardiology clinic for postsurgical follow up and transthoracic echocardiography revealed a large non-homogenous mass in LA with right atrium invasion, which was confirmed by trans-esophageal echocardiography. The patient underwent surgical resection of tumor and the pathological diagnosis was malignant fibrous histiocytoma (MFH).Conclusion:MFH could be asymptomatic and the diagnosis be established as a surgical or complementary examination. In patients with history of myxoma resection and cardiac masses, further evaluation is recommended.

Totally Endoscopic Resection of Giant Left Atrial Myxoma without Robotic Assistance

Totally Endoscopic Resection of Giant Left Atrial Myxoma without Robotic Assistance

Refractory Heart Failure despite Optimized Medical Treatment Which Subsides only after Surgical Resection of a Large Left Atrial Myxoma

Refractory Heart Failure despite Optimized Medical Treatment Which Subsides only after Surgical Resection of a Large Left Atrial Myxoma

Left atrial giant myxoma resection with video-assisted minimally invasive method

Minimal invaziv kalp cerrahisi halen gelismekte olan bir tekniktir. Video destekli sag anterolateral mini torakotomi ile yapilan cerrahi en sik kullanilantekniklerdendir. Bu yazida 48 yasinda kadin hastada gecici iskemik atak sonrasinda tani konulan dev sol atriyal miksomanin video destekli minimalinvaziv yontemle cikartilmasi ve hastada olusan atriyal septal defekt ve mitral yetmezlik tamirlerinin hastaya ek ameliyat riski getirmeden ayni seanstayapilabilecegi gosterildi.

Multiple cerebral aneurysms detected 20 years after resection of left atrial myxoma in a patient with carney complex

Multiple cerebral aneurysms detected 20 years after resection of left atrial myxoma in a patient with carney complex

Heart Surgery Practice in Sub Saharan Africa: Single Nigerian Institutional Midterm Results and Challenges

Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.

Multiple intracranial aneurysms followed left atrial myxoma: case report and literature review.

Cerebral aneurysms follows atrial myxoma is a rare neurological complication. We report a patient with multiple cerebral aneurysms three years after resection of left atrial myxoma and further review the literature. The characteristics of these aneurysms are indefinite and variable. They can occur prior or post the resection of cardiac myxoma. "Metastasize and Infiltrate" theory may be the key mechanism in the formation of these aneurysms. Magnetic resonance imaging (MRI), computed tomography (CT) and angiography are useful in the diagnosis while digital subtraction angiography (DSA) is the best choice. There are no definite guidelines for therapy of these aneurysms. Resection of the cardiac myxomas, chemotherapy, radiotherapy, coil embolization and surgical treatment could be helpful.