V S Lad | PubMed Health

PubMed2005

Right atrial trans-septal approach for left atrial myxomas--nine-year experience.

OBJECTIVE: In this single-center study we reviewed our experience with left atrial myxomas occurring over the past 9 years. METHODS: Sixty-three patients underwent excision of cardiac myxomas between 1995 and 2004. Of these, 56 patients (32 females and 24 males) had left atrial (LA) myxoma. The mean age was 37.80+12.97 years (range 3.5-67 years). Echocardiography was the only diagnostic evaluation done. The preferred approach for resection was right atrial trans-septal. Annual echocardiographic evaluation was undertaken following surgery. Follow-up is current and available in all the survivors (range 4 months-9 years). RESULTS: Clinically 75% of the LA myxomas simulated mitral stenosis. The symptoms were present for 2-6 months before operation. Most (86%) LA myxomas were attached to the fossa ovalis. Few (14%) originated from the LA wall, mitral valve annulus and anterior mitral leaflet. One patient succumbed to low cardiac output and another died of massive embolic stroke following surgery. There were no late deaths. Two patients (3.7%) developed left hemiparesis after operation but recovered completely. There was one (1.9%) recurrence 3 years after surgery. Atrial fibrillation occurred in one patient. Mitral insufficiency which was seen in two (3.7%) patients prior to surgery subsided following excision of the tumor. Postoperatively 94% patients remained without symptoms. CONCLUSION: Owing to the risk of valvular obstruction or embolization early surgery is indicated. Right atrial trans-septal approach is safe and easy. Most patients are asymptomatic following surgery. A yearly follow-up is essential.

Adolescent↗

PubMed2004

Maze III replication using radiofrequency microbipolar coagulation.

BACKGROUND: The major concerns about the Cox's Maze III procedure have been the long bypass and cross-clamp times involved. We have developed a technique using microbipolar coagulation to duplicate most of the incisions described in the Maze III procedure. TECHNIQUE: This procedure is performed using standard hypothermic cardiopulmonary bypass and cold sanguineous hyperkalemic arrest. The left atrial Maze is performed using microbipolar coagulation following repair or following valve excision, prior to replacement. Cryolesions are used instead of radiofrequency at the mitral annulus to avoid injury to the circumflex coronary artery. Valve replacement is then done and the left atriotomies are closed. After rewarming, adequate deairing and removal of the aortic cross-clamp, the right atrial procedure is performed using microbipolar coagulation except ends of the radiofrequency lesion lines at the tricuspid annulus, where cryolesions are used. The rest of the surgery proceeds as usual. We used this procedure concomitantly with valve surgery in 84 patients. Sinus rhythm was restored in 86% of them. CONCLUSIONS: The use of radiofrequency energy in the microbipolar mode is safe and effective. The technique is easily reproducible and the tools involved are inexpensive and readily available. Although the cure rate is less compared to Cox's Maze III procedure and there is an attrition rate, sinus rhythm and atrial mechanical function is restored in the majority and with brief additional operative time.

Journal Article↗