Transaortic Video-Assisted Resection of a Recurrent Left Ventricular Myxoma

An asymptomatic 57-year-old woman presented for resection of a fifth cardiac myxoma. To avoid complete redissection of the heart, we proposed a video-assisted transaortic approach for a recurrent left ventricle (LV) myxoma resection. In a hybrid approach, sternotomy and open aortotomy provided the minimally invasive transaortic access to the myxoma. The myxoma was discovered during a routine echocardiographic screening. A 30° 5-mm scope, video-assisted thoracic surgery graspers, and endoshears were used for resection. The video-assisted technique significantly enhanced the intracardiac visualization, and a smaller, second myxoma was discovered after resection of the primary lesion. Both myxoma beds were additionally ablated to prevent recurrence. The total video-assisted operating time was 58 minutes. The transaortic valve approach avoided an atriotomy or ventriculotomy in a fifth redo operation. A transaortic valve approach to LV intracardiac lesions is safe and feasible, and it provides excellent visibility for complex cardiac cases.