Redo totally endoscopic 3D surgery for recurrent left atrial myxoma causing cerebrovascular accidents with a novel technique: A case report

Abstract

Background: Recurrent left atrial myxoma is rare but clinically significant due to its potential for embolic complications, including cerebrovascular accidents (CVA). Minimally invasive redo procedures remain technically challenging, particularly in the presence of postoperative adhesions.

Case presentation: We report the case of a 39-year-old Asian female with a history of totally endoscopic myxoma resection via axillary thoracotomy in June 2023, who presented with new-onset right upper limb weakness. Imaging revealed a recurrent left atrial myxoma (20 × 30 mm) attached to the interatrial septum, along with acute ischemic infarcts in the left cerebral hemisphere. The patient underwent successful redo totally endoscopic 3D surgery using a right atrial approach and a double-port (Double-port approach, Camera and main port in the same intercostal space, Totally endoscopic with a skin incision <3 cm, DCT) technique. Partial resection of the interatrial septum was performed to minimize recurrence risk. Cardiopulmonary bypass and aortic cross-clamp times were 110 and 90 minutes, respectively. Recovery was uneventful, with complete neurological and cardiac function restored.

Conclusion: This case demonstrates that redo totally endoscopic 3D resection of recurrent left atrial myxoma is feasible and safe, even in the setting of pleural adhesions. The right atrial approach, combined with the DCT technique, offers a precise and minimally invasive strategy for managing recurrent cardiac tumors with embolic potential.