Methods
A total of 20 patients undergoing surgery for atrial myxoma resection from Jan. 2011 to Sept. 2020, were included in the analysis. Ethics approval and consent to participate that have read and understood by patients with information about the research as provided in the participant information sheet inside his file. The study conformed to the principles of “Declaration of Helsinki” and the investigator followed the appropriate safeguards regarding the rights and welfare of the human participants that have been included in the performed study. Consent for publication was obtained written consent from patients. There were 10 patients who underwent resection through ST and 10 patients who underwent resection through MI approach.
In case of median ST, standard aorto-bicaval , moderate hypothermia (32°-, and direct cold blood cardioplegia. In cases MI approach, peripheral femoral cannulations were utilized to establish CPB by a Seldinger technique. The left femoral artery was cannulated with (16- ) arterial cannula, and the left femoral vein was cannulated with () venous cannula. TEE is utilized to check the position of venous cannula in the superior vena cava. Mini-thoracotomy incision (4-) was made in 4th or 5th intercostal space medial to the anterior axillary line. The pericardium was opened above and parallel to phrenic nerve and extended over the aorta. Venous drainage was augmented with vacuum assistance applying negative pressures (30 Hg) to empty the right side. and were snuggared before right atriotomy. A retrograde cardioplegic cannula was directly inserted after right atriotomy. Aortic cross clamping was done through 2ndright intercostal space by a Chitwood clamp. Carbon dioxide blower was used into the operative field. De-airing was performed with a needle in the root of the aorta and under TEE guidance. With the heart empty, both atrial and ventricular pacing wires were placed. After discontinuing and administering protamine, decannulation was performed. The purse string sutures were tied and the femoral artery was directly repaired using 5/0 Prolene. A single or two chest tubes were placed in right pleural space and pericardium. The mini-thoracotomy incision was closed in the standard fashion (Figure 2) . Myxoma was approached through the right atriotomy. Myxomas are pedunculated, friable and appear as a soft, gelatinous, with areas of hemorrhage or thrombi (Figure 3) . The pedunculated Myxoma was excised with its attachment to interatrial septum, and septal defect was closed directly or with autologous pericardial patch. Intraoperative TEE revealed no residual tumor, no residual defect, complete deairing, and no valvular insufficiency. Pathological examination was confirmed benign myxoma (Figure 4) . Follow up after (6) months by TTE revealed no recurrence and normal functioning mitral and tricuspid valves.