CLINICAL CASE

RESECTION OF ATRIAL MYXOMA

Angie Bautista - 01200022008
Ana Bothia - 01200022011
 CASE DESCRIPTION
• Names and surnames: Luisa Perez
• Age: 78 years
• WEIGHT: 57 kg
• Female gender
• Place of residence: Lagos del Cacique
• Marital status Married
• Blood type: O+
• Surgical history: Does not refer
•Allergies: Not reported
•Pharmacological: losartan, sertraline, levothyroxine.
•Pathological: HBP, hypothyroidism, ischemic stroke, viral encephalitis,
hearing loss.
DIAGNOSTIC METHODS
Coronary arteriography with left
catheterization.
chest x-ray
Transesophageal echocardiogram
Uroanalysis
Blood tests
Doppler ultrasound of neck vessels
 CORONARY ARTERIOGRAPHY WITH LEFT CATHETERISM

In the present study we have documented

coronary arteries without obstructive
lesions. View Report. Based on the
clinical picture and results of this study,
we recommend continuing medical-
pharmacological management and control
of cardiovascular risk factors.
 CHEST X-RAY

-Cardiac xylote of normal size.

-There is no consolidation or pleural effusions.

-Normal-appearing lung muscles.

-Degenerative changes in the dorsal column.

 TRANSESOPHAGEAL ECHOCARDIOGRAM
Conclusions:
1. Left ventricle with normal size and systolic function. F.E 61%
2. Diastolic function is normal for the patient's age.
3. Right ventricle of normal size and systolic function.
4. Aortic valve sclerosis with mild insufficiency.
5. Mitral valve sclerosis with mild insufficiency.
6. Mild tricuspid insufficiency.
7. A mass is observed in the left atrium with some heterogeneous
echoes inside, with defined edges, measuring approximately 21x21 mm
in its long axes, attached by a pedicle to the interatrial septum in the
oval fossa.

Comments:
Echocardiographic findings are consistent with left atrial myxoma.
DIAGNOSIS

LEFT ATRIAL MYXOMA

It is a non-cancerous tumor that occurs
on the upper left or right side of the
heart. It almost always grows on the wall,
called the interatrial septum, that
separates the two sides of the heart.
 SURGICAL PROCEDURE TO BE PERFORMED

Atrial Myxoma Resection

Perform surgical removal of the tumor
located in the left atrium.
 ANATOMY

The heart is made up of four chambers, two

atria and two ventricles. The atria are
separated from each other by an interatrial
septum and the ventricles by an
interventricular septum. Between the
atrium and the ventricle there is a valve
called the atrioventricular valve.
 ANATOMY

The heart is made up of 3 layers:

Pericardium - it is like a sheet that
surrounds it on the outside
Myocardium - is the heart muscle,
responsible for propelling blood
through the body through its
contraction.
Endocardium - is a thin layer that
covers the inside.
 ANATOMY

Left atrium:
It is the most posterior chamber of the heart. It
receives the 4 pulmonary veins at their angles.
Its most distinctive feature is the appendage,
which is narrow, hook- or finger-shaped. In its
Inside you can identify the mouths of the 4
pulmonary veins, the septum
interatrial and the orifice of the mitral valve, which
communicates with the left ventricle.
 IMPORTANT DATA FOR THE
PROCEDURE

F.E: 61% TYPES OF CANNULATION

BODY SURFACE: 1.59 Arterial cannulation: Cannula #20 at the
FLOW: 3.98 root of the aorta
HEPARIN: 3.99 Venous Cannulation: Selective: Superior
vena cava (venous cannula #24) Inferior
vena cava (venous cannula #28)
Cardioplegia: Anterograde Root
CHECK LIST
TABLE SETTINGS
 POSITION OF THE PATIENT AND LOCATION OF THE SURGICAL
EQUIPMENT

Supine Position
 POSSIBLE SYMPTOMS THAT THE PATIENT COULD HAVE HAD

-Difficulty breathing when lying on either side

-Difficulty breathing when asleep
-Chest tightness or pain
-Dizziness
-Fainting
-Feeling of heartbeat (palpitations)
-Shortness of breath with activity
-Symptoms due to embolism of tumor material
 SURGICAL PROCEDURE

SURGICAL PROCEDURE INSTRUMENTAL

1. Incision and hemostasis are made in the skin. 1. Scalpel handle #7 Scalpel blade #15
2. The opening of the sternum is made. 2. Reciprocating saw.
3. We perform the separation of the pericardium, We remove a 3. Scalpel handle #7 Scalpel blade #11 and Silk 0 con SH.
portion of the pericardium and then place it as a graft in the septum. 4. Heparin.
4. We place 20,000 units of heparin. 5. Ti-cron 2/0 With needle de ½.
5. The first purse is performed in the aorta. 6. Precut 1 silk.
6. We perform the first tourniquet placement in the superior vena 7. Ti-cron 2/0 With needle de ½.
cava. 8. Precut 1 silk.
7. We place the second purse in the Superior vena cava. 9. Ti-cron 2/0 With needle de ½.
8. Placement of the Third tourniquet in the inferior vena cava. 10. Prolene 4/0 con RB1.
9. Perform the third purse in the inferior vena cava.
10. The tourniquet is placed in the aorta for the cardioplegia
cannula.
 SURGICAL PROCEDURE INSTRUMENTAL

11. #20 cannula.

11. Arterial cannulation is performed in the aorta
12. Scalpel handle #7 Scalpel blade #11 and #24 cannula.
12. Cutting and placing the cannula in the inferior vena cava.
13. Cardioplegia cannula.
13. Placement of the cardioplegia cannula in the aorta.
14. Total aortic clan.
14. We place the total Clan between the heart disease cannula and
15. Auricle stopper.
the Superior vena cava cannula.
16. Scalpel handle #7 Scalpel blade #11
15. We separate the tourniquet until we find the tumor.
17. Prolipropileno 4/0 con RB1.
16. Reception of the tumor is done.
18. Polipropileno 5/0 con SH.
17. Placement of the pericardial patch on the septum.
19. Pacemaker wire 2/0
18. We close the atrium.
20. Scalpel handle #7 Scalpel blade #11 and chest tube 32-34.
19. We place the pacemaker wire in the epicardium.
21. Polipropileno 4/0 con Rb1.
20. We use a skin contracture to place the chest tubes.
22. Venous cannulas and arterial cannula.
21. Close up of cardioplegia cannula puncture in the atrium.
23. Metzenbaum scissors.
22. We remove the venous cannulas and arterial cannulas.
24. Electrobisturi.
23. The separation points in the pericardium are removed.
25. Surgical wire 6.
24. Hemostasis of the sternum and revision of the cavity are
26. Bupivacaina al 2% sin Epinefrina.
performed.
27. Gauze and compresses.
25. Closure of the sternum is performed.
28. Poliglactina 910 0 con ct-1.
26. Infiltration is performed.
29. Monocryl 3/0 With needle 3/8
27. We carry out a final count.
30. Gauze, Tegaderm. Dermabon and leukomed.
28. Closing of Terrestrial phases and subcutaneous cellular tissue.
29. Leather closure.
30. We perform healing.
 COMPLICATIONS

Complications may include:

-Arrhythmias
-Pulmonary edema
-Peripheral emboli
-Blocked heart valves
GRACIAS