Extensive Resection and Double-Patch Reconstruction for Left Atrial Myxoma

Abstract

The efficacy and safety of surgical intervention for atrial myxoma are established, but the operative approach to tumor resection and atrial reconstruction are controversial. A biatrial approach is generally used for excision of atrial myxoma and has many advantages. In contrast, there are a few reports about the method of double-patch reconstruction, and the right and left atrium are individually reconstructed with the two patches. We found it to be effective in the case reported here. We suggest that this method can be applied to atrial myxoma in which extensive resection is necessary.

Artificial Neochordae for Tricuspid Valve Repair in Adults: A Review

“…Table 2 summarizes nine cases of TR due to IE in whom TVr was achieved using ePTFE neochordae. 33 34 35 36 37 38 39 40 41 There were five males and four females, aged 19 to 77 years (mean, 40 years); pathological features consisted predominantly in vegetations of the anterior tricuspid leaflet causing leaflet perforation or destruction in two patients, 34 41 associated with a right ventricular abscess in another. 36 Staphilococcus was the most frequent responsible agent, 33 35 36 40 41 followed by Pseudomonas in two patients 34 39 and Enterococcus 37 and Candida 34 in one each.…”

“…Repair consisted in patch reconstruction of tricuspid leaflets after generous debridement and vegetectomy, using autologous pericardium 34 35 36 37 and bovine 39 41 or equine 40 pericardium. Tricuspid annuloplasty was added to TVr in five cases, using a prosthetic ring in three 38 39 41 and a strip of autologous pericardium in other two. 35 40 The neochordae were generally attached to the reconstructed anterior tricuspid leaflet; their size was 4/0 and 5/0 but it was not always specified as the number of chords utilized.…”

“…36 45 61 In many reported cases of patients with IE-related TR, extended resection of infected leaflets and subvalvular apparatus was required. Valve reconstruction was accomplished with patches of pericardium, while the neochordae were sutured to the free margin of the patches 38 40 41 ( Fig. 1B ).…”

Indication and Timing of Surgery in Patients with Endocarditis of the Tricuspid Valve

“…The main principles of surgical management include [10]: (a) radical debridement of vegetations and infected tissue, (b) avoidance of prosthetic material, particularly in drug addicts, and (c) correction of tricuspid regurgitation. There are two surgical techniques, the first known as "non-prosthetic" [11], involving either (a) complete removal of the existing vegetations (vegetectomy) or (b) complete removal of the valve leaflets and cords (valvulectomy). Both are advantageous in drug addicts and should be considered in the first line of treatment, as drug addicts run a high risk of complications due to poor compliance with anticoagulant treatment and reinfection linked to resumption of drug use [10, However, in the case of extensive lesion in more than one leaflet of the valve, repair is not possible and complete excision of the valve (valvulectomy) should be considered [12].…”