EXTENDED VERTICAL TRANSATRIAL SEPTAL APPROACH FOR THE REMOVAL OF LEFTATRIAL-MYXOMA

Objective: Optimal exposure greatly facilitates left atrial myxomectom y and is mandatory for safe and efficacious tumour removal. The purpos e of this study was to evaluate one institutions experience, with an a lternative to the classical approach, for the removal of left atrial m yxoma. Methods: In an eight-year period, eight patients underwent surg ical removal of left atrial myxoma at our institution using the extend ed vertical transatrial septal approach, slightly modified compared to the original method of Guiraudon and associates, as the septum was in itially incised superiorly instead of through the fossa ovalis. Result s: One patient with poor left ventricular function died shortly after the surgical procedure because of low cardiac output. Postoperative co urse of the other patients was uneventful. No rethoracotomy for bleedi ng was carried out and no permanent arrhythmias were seen. There was o ne 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 re vealed six asymptomatic healthy patients. Conclusions: We feel that th e extended vertical transatrial septal approach provides good exposure of left atrial tumours and facilitates complete surgical removal with out inherent complications such as tumour cell dissemination or fragme ntation. (C) 1998 Elsevier Science B.V.