Objectives
Cardiac myxoma is the most common primary benign cardiac tumor and
managed by surgical excision. However, it can occur within any cardiac
chamber, a majority of them are located in LA (75%), in RA (15),
biatrial (2.5%), very rare in ventricles and valve. Atrial myxomas
arise from interatrial septum, at the border of fossa ovalis[1] . Depending on size, site, and mobility of the mass,
myxomas give manifestation of obstruction or embolization, or
constitutional symptoms. If the myxoma is large pedunculated and mobile,
can obstruct the valve, resulting in sudden death. Therefore, myxomas
should be resected surgically, once diagnosis confirmed[2] . Diagnosis is done mainly by echocardiography (TTE-TEE)
or other imaging; like computed tomography (CT), and magnetic resonance
imaging () (Figure 1) . Resection of myxomas is safe, with very
low mortality and morbidity [3] . Early diagnosis is
challenged because its symptoms are nonspecific. Clinical manifestation
includes fever, chest distress, dyspnea, anemia, syncopal attack, and
embolism [9]. Large myxomas may be asymptomatic if the
growth is very slow [5] . Atrial myxomas are usually
considered as an indication for urgent surgery [10] . It is
very rare procedure; its incidence in cardiac surgery operation is about
0.3% [4] . Advanced imaging provides more accurate
evaluation of size, site, shape, and attachment. So, exploration of all
chambers may not be required intraoperative. MI approach should be
considered as a treatment option [5].
Several surgical approaches (isolated left or right atriotomy, right
atriotomy with trans-septal incision, and bi-atrial approach) and chest
incision (median sternotomy and mini-thoracotomy) have been used for
myxoma resection [11]. Myxomas usually are managed by
complete excision through a median ST. However, the poor cosmetic effect
and possible complications of ST are occasionally troublesome. The
concept of MICS has been introduced recently to cardiac surgery. MICS
has potential benefits such as increased patient satisfaction, less
pain, decreased length of ICU and hospital stays, improved quality of
life, and so decreased costs. The safety and efficacy of MICS approach,
in comparison to ST approach, for atrial myxoma resection has proven
challenging [6-7-8].