Discussion:
Our patient had a large dime-sized fenestration in his CTS membrane with minimal (3mm) intra-atrial gradient. Although there was small gradient, there was a significant obstruction of flow. The patient also had a patent foramen ovale, which allowed for left-to-right shunting and allowed for left atrial decompression into the right atrium. This led to a gradual left and right atrial dilation over 60 years and the subsequent development of dyspnea and atrial fibrillation, which is the most common trigger for presenting at a later age.3
Minimally invasive anterior thoracotomy is a well-described technique for repair and replacement of mitral valves. It provides reduced post-operative pain, decreased infection, improved cosmesis, and reduced length of stay.4 For repair of CTS, it provides excellent exposure of the left atrium allowing for complete assessment of the pulmonary veins, left atrial appendage and the CTS membrane. This is only the second reported case of minimally invasive repair of CTS in the literature to our knowledge. 5 We believe that minimally invasive anterolateral thoracotomy should be the preferred method for treatment of CTS as well as other left atrial and mitral pathology.
Conflicts of Interest :
There are no conflicts of interest