Minimally Invasive Left Atrial Myxoma Resection Using 3D Technology

The atrial myxoma is the most frequent cardiac tumor, located in the left atrium in 75 percent of the time (1). The most dangerous presentation is the papillary, which indicates is the surgical removal with the aim to avoid embolic complications (2-5). The minimally invasive approach (MICS) has shown to be a feasible technique. The MICS approach has shown relevance recently based on benefits such as less trauma, bleeding, postoperative pain, and faster rehabilitation (6, 7). Resection through a MICS-3D HD has some advantages because it allows faster and better visualization with a deep understanding of the pathology. Some groups have shown improvements in the learning curve when using 3D technology compared with classic 2D (8, 9). There are plenty of controversies regarding the MICS-3D approach such as pleural adhesions, ascending aorta calcification, severe femoral artery calcification, aortic regurgitation ≥2+, or thoracic wall deformities. Therefore, the indication and the patient-selection criteria must be chosen thoroughly. This video presents a case of a left atrial myxoma resection through a MICS-3D video-assisted approach, a technique not often described in the literature, and demonstrates how it can be performed effectively. The Patient A sixty-seven-year-old man with a history of hypertension and NYHA I presented with hemiparesis on the right side of the body. A cerebral magnetic resonance image (MRI) was performed, and an ischemic lesion was observed at the left parietal lobe. The catheter lab showed no coronary lesions. In the transesophageal echocardiography (TEE) a 7.9 cm mass located in the left atrium and implanted at the fossa ovale bulging to the left ventricle was observed, and then confirmed with cardiac MRI (Fig. 2 B, C). Based on this information, the team decided on surgical resection. The Surgery First, a right minithoracotomy was performed between the fourth and fifth intercostal space (ICS). Two 5 mm accessory ports were used to insert the Chitwood aortic clamp in the right third ICS at the midaxillary line and a 3D video camera at the right fourth ICS. Surgeons used 3D glasses during most of the procedure. A Mohr atrial retractor, long-shafted instruments for minimally invasive surgery, and long-shafted knotters were used. A Storz video camera with a mechanical arm was also used. Long arterial and venous cannulas for CPB management were inserted through a minimal 3-4 mm incision in the femoral artery, femoral, and jugular vein. T