Discussion
Although myxomas are the most commonly seen primary cardiac tumors, they remain a very rare. The presenting symptoms of an atrial myxoma are widely variable and non-specific. Regardless of presentation, once a diagnosis is made urgent surgical excision is recommended to avoid the potential complications [12]. So, we reported small number of cases during long period. All patients were discovered incidentally during TTE examination.
Around 30% of the patients presented with signs and symptoms associated with secondary embolization [13]. So, once diagnosis was done surgical excision was performed to avoid incurable complications.
Biatrial exposure has been the preferred approach for complete surgical excision. MI approach has been increasingly used in the field of cardiac surgery [4-5]. In our study, we used to right atriotomy trans-septal approach for LA myxomas.
Accurate imaging of cardiac myxomas before surgical resection is critical for operative success. Myxomas are often detected with echocardiography, CT, or CMR [11] . Echocardiography serves as a cornerstone of workup in the evaluation of ischemic stroke, as (15%) are cardiac causes [14] . We reported only two cases done MRI after TTE diagnosis. Advanced diagnostic imaging helped us to be ensured there were not multiple myxomas, that were needed more exploration.
Surgical excision is the treatment of choice for atrial myxoma resulting in a complete cure (99%), and recurrence in (1%) [15] . Incomplete resection of the myxoma attachment area is considered the common cause of recurrence [16] .So, we excised myxoma with its interatrial septal attachment the repair the defect.
When compared with a median ST approach, the reported benefits of MICS include reduced; surgical trauma, blood loss, need for reoperation, and pain, early return to normal daily activity, shorter ICU and hospital stays, reduced costs, and higher level of patient′s satisfaction[8]. We reported in our study that MI approach reduced time of hospital stay, no reopening due to bleeding, better cosmetic wound appearance, and more patient′s satisfaction.