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Two-Port Endoscopic Left Atrial Myxoma Resection Under Ventricular Fibrillation Without Aortic Cross-Clamping
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Objective:
To describe a reproducible 2-port, 3-dimensional totally endoscopic technique for left atrial myxoma resection under ventricular fibrillation without aortic cross-clamping.
Key Steps:
Peripheral cardiopulmonary bypass is established through femoral cannulation. After 2 right thoracic ports are positioned, ventricular fibrillation is induced, the left atrium is opened, and a left atrial vent is inserted. The tumor is removed en bloc with an adequate septal margin. Continuous carbon dioxide insufflation, titrated venting, a gently blood-filled left atrium, and transesophageal echocardiography-guided de-airing provide embolic protection.
Potential Pitfalls:
Aortic regurgitation, interatrial shunting, inappropriate venting, tumor fragmentation, and prolonged fibrillatory arrest can compromise safety.
Take-Home Messages:
In carefully selected patients, a short fibrillatory interval can simplify 2-port myxoma resection by avoiding aortic clamping, root cannulation, and cardioplegia. Meticulous left-heart decompression and de-airing are essential.
