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Eur J Cardiothorac Surg 1998;13:90-93
© 1998 Elsevier Science NL

Extended vertical transatrial septal approach for the removal of left atrial myxoma

Department of Cardiovascular and Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

Received 8 July 1997; received in revised form 22 October 1997; accepted 29 October 1997.

Corresponding author. Present address. Department of Surgery, University Hospital Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Tel.: +31 50 3616161; fax.: +31 50 3613043.

Objective: Optimal exposure greatly facilitates left atrial myxomectomy and is mandatory for safe and efficacious tumour removal. The purpose of this study was to evaluate one institutions experience, with an alternative to the classical approach, for the removal of left atrial myxoma. Methods: In an eight-year period, eight patients underwent surgical removal of left atrial myxoma at our institution using the extended vertical transatrial septal approach, slightly modified compared to the original method of Guiraudon and associates, as the septum was initially incised superiorly instead of through the fossa ovalis. Results: One patient with poor left ventricular function died shortly after the surgical procedure because of low cardiac output. Postoperative course of the other patients was uneventful. No rethoracotomy for bleeding was carried out and no permanent arrhythmias were seen. There was one late death at 4.5 months after operation, for which no clear reason was found. Mean follow-up was 55 months (range 1 to 79 months) and revealed six asymptomatic healthy patients. Conclusions: We feel that the extended vertical transatrial septal approach provides good exposure of left atrial tumours and facilitates complete surgical removal without inherent complications such as tumour cell dissemination or fragmentation.

Key Words: Left atrial myxoma • Extended vertical transatrial septal approach • Surgical excision

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