Left Atrial Dissection and Rupture Following Excision of Left Atrial Myxoma: Role of Transesophageal Echocardiography

Left atrial mass after excision of a left atrial myxoma may occur due to residual or additional masses, such as biatrial or multicentric myxomas and inverted left atrial appendage. In this E-challenge, the authors present a case where intraoperative transesophageal echocardiography allowed visualization of a left atrial mass after excision of a left atrial myxoma. Detailed examination demonstrated that the mass was due to left atrial dissection that progressed to rupture, allowing its early detection and repair. A high index of suspicion, as well as coordination between the surgeon and the perioperative echocardiographer, played a crucial role in the detection and management of this complication.     

Inverted T-Shaped Biatral Incision for Large Left Atrial Myxoma

A bstract 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.     

左房粘液瘤的外科治疗

目的：总结左房粘液瘤的临床表现，诊断手段及外科手术治疗时机的把握，方法：本组30例术前均由超声心动图诊断，共接受32例次手术治疗，体外循环下平均阻断主动脉23．7（11－40）min。结果：本组患中24例心功能恢复良好，痊愈出院，随访无复发；6例术后早期死亡，死亡原因为心律失常，低心排综合征和多系统器官衰竭，结论：左房粘液瘤为心脏良性肿瘤中常见的类型，把握手术时机，避免肿瘤脱落引起栓塞等并发症的发生是手术成功的重要因素。     

巨大左房顶部黏液瘤的外科治疗——附3例报告

目的探讨巨大左房顶部黏液瘤的手术治疗难点。方法 2010年1～10月,对3例巨大左房顶部黏液瘤（7cm×4 cm×3 cm,8 cm×5 cm×4 cm,9 cm×6 cm×5 cm）行手术切除,男1例,女2例,年龄48、58、73岁,心功能Ⅱ级1例、Ⅳ级2例。采用房间隔入路手术,探查瘤体巨大,远超正常心房径线,几近充满患者扩大的左房,显露、切除操作困难。片除蒂部心内膜和内膜下心肌,以自体心包补片加固蒂部薄弱房顶组织、修补房间隔缺损。结果术中无左房顶部出血发生。1例因伤口部分愈合不良,行局部清创缝合,余无手术并发症,均康复出院。术后随访3、6、12个月,心功能均为Ⅱ级,超声心动检查无肿瘤复发,肺动脉高压和三尖瓣返流消失。结论切除巨大左房顶部黏液瘤时,术中显露很困难,可先行部分切除,良好显露后完整切除肿瘤。预防心房穿破出血是手术关键,自体心包修补房顶组织是良好处理方法。     

Considerations in the Surgical Management of Left Atrial Myxoma

Myxomas are the most common tumors of the heart. They are frequently located in the left atrium and produce symptoms when they fragment and cause systemic emboli or when they interfere with cardiac valvular function and cause pulmonary congestion. Careful surgical management of these lesions should be curative with minimum early and late morbidity and mortality. Optimal operative technique emphasizes minimal manipulation of the heart before institution of cardiopulmonary bypass and aortic cross-clamping and careful examination of intracardiac chambers with meticulous removal of myxomatous debris. Using these techniques, 17 patients have been treated successfully at the Brigham and Women's Hospital. There were no operative deaths and no significant perioperative morbidity. Fifteen patients are asymptomatic, and one patient has minimal shortness of breath an average of 57 months after surgery. One patient died of leukemia 15 months postoperatively. No recurrent myxomas have been identified, and no patients have symptoms of other cardiac disease.