SUPERIOR TRANSSEPTAL APPROACH FOR SURGICAL REMOVAL OF LEFT ATRIAL-MYXOMA

Eight patients (4 men, 4 women), mean age 51 years, referred to our In stitution for left atrial myxoma underwent removal of the tumor throug h a superior transseptal approach. All patients in sinus rhythm with n ormal conduction time. The myxomas were localized in the fossa ovalis (3 cases), interatrial septum (2 cases), left appendage (2 cases), and mitral annulus (1 case). One patient died in hospital after emergency operation for low-output syndrome complicated by septic shock. All ot her patients had an uneventful postoperative course. Atrial arrhythmia s did not represent a major postoperative complication. Transient PR i nterval elongation was occasionally seen. Electrophysiological studies showed normal sinus node function. At 6 months following operation, p atients were evaluated with transesophageal echocardiography. There wa s no tumor recurrence. There were no episodes of arrhythmia in 24-hour electrocardiographic monitoring, and all patients were in NYHA Class 1. We believe that the superior transseptal approach gives optimal exp osure of the left atrial cavity, overcoming all difficulties related t o a small left atrium which is an usual pattern in left atrial myxomas .