Transverse infundibulotomy for resection of a right ventricular outflow tract myxoma

A 25-year-old asymptomatic 64 kg female with an incidental heart murmur was found, on echocardiography, to have a 2 cm echogenic mass beneath the pulmonary valve, with a peak gradient of 11 mmHg and mild pulmonic regurgitation. Gated computed tomography angiogram showed that the mass was located within the infundibulum of the right ventricle, beneath the non-adjacent leaflet of the pulmonary valve. The tumour had a broad base attachment to the interventricular septum and was in close proximity to the left anterior descending artery. The patient underwent median sternotomy via a limited skin incision. Cardiopulmonary bypass was initiated via aortic, superior vena cava and femoral vein cannulation. After diastolic cardioplegic arrest, a transverse infundibulotomy was made. A firm, multilobulated tumour was excised en bloc with a shallow cuff of septal muscle, including a white pedunculated base and gelatinous yellow stalk. A feeding septal artery was oversewn. The infundibulotomy was closed in two layers with 5/0 polypropylene sutures. The heart was de-aired, the cross-clamp removed, and the procedure completed routinely.