Inverted T-shaped biatral incision for large left atrial myxoma

Various surgical approaches for a left atrial myxoma have been developed to provide optimal exposure and to allow radical excision of the tumor. However, when a myxoma occupies most of the left atrium, it is difficult to remove the friable tumor without fragmentation. The inverted T-shaped biatrial incision is a modified transseptal approach to expose the mitral valve. Using this approach, we can extirpate even a huge tumor without fragmentation. A horizontal incision of the left atrium is made, followed by a vertical incision into the right atrium. A careful assessment is made as to whether or not this biatral approach is sufficient to remove the large left atrial myxoma. If exposure is considered inadequate, the interatrial groove is divided. The incision is continued distant from the pedicle, if possible, more than 5 mm away. The tumor is excised, including tissue around the base of the tumor, with wide margins.