Two-Port Endoscopic Left Atrial Myxoma Resection Under Ventricular Fibrillation Without Aortic Cross-Clamping.

OBJECTIVE

To describe a reproducible 2-port, 3-dimensional totally endoscopic technique for left atrial myxoma resection under ventricular fibrillation without aortic cross-clamping.

KEY STEPS: Peripheral cardiopulmonary bypass is established through femoral cannulation. After 2 right thoracic ports are positioned, ventricular fibrillation is induced, the left atrium is opened, and a left atrial vent is inserted. The tumor is removed en bloc with an adequate septal margin. Continuous carbon dioxide insufflation, titrated venting, a gently blood-filled left atrium, and transesophageal echocardiography-guided de-airing provide embolic protection.

POTENTIAL PITFALLS: Aortic regurgitation, interatrial shunting, inappropriate venting, tumor fragmentation, and prolonged fibrillatory arrest can compromise safety.

TAKE-HOME MESSAGES: In carefully selected patients, a short fibrillatory interval can simplify 2-port myxoma resection by avoiding aortic clamping, root cannulation, and cardioplegia. Meticulous left-heart decompression and de-airing are essential.