Minimal invasive, partially video-assisted right anterolateral thoracotomy is a viable and effective approach for the urgent extraction of massive left atrial thrombus and mitral valve replacement.
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Minimally invasive extraction may succeed in select cases; leaves open need for comparative trials before wider use.
A 62-year-old female patient with history of atrial fibrillation and protein C and S deficiency was admitted for acute dyspnea. Laboratory control demonstrated an unregulated warfarin treatment. Transthoracic echocardiography and computed tomography revealed a giant left atrial thrombus and a severe mitral stenosis. The day after admission a full body tomography revealed spleen emboli and non-violation of hematoencephalic barrier. Surgical thrombus extraction and mitral valve replacement were successfully performed by minimal invasive, partially video-assisted, right anterolateral thoracotomy. Echocardiographic control after two months showed no evidence of residual thrombus. Massive left atrial thrombosis must be operated urgently because of the imminent risk of embolization. The described technique represents a good compromise between full video-assisted port-access surgery and traditional midline sternotomy.
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Marinakis et al. (2019) studied this question.
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