Discussion:
Our patient had a large dime-sized fenestration in his CTS membrane with
minimal (3mm) intra-atrial gradient. Although there was small gradient,
there was a significant obstruction of flow. The patient also had a
patent foramen ovale, which allowed for left-to-right shunting and
allowed for left atrial decompression into the right atrium. This led to
a gradual left and right atrial dilation over 60 years and the
subsequent development of dyspnea and atrial fibrillation, which is the
most common trigger for presenting at a later age.3
Minimally invasive anterior thoracotomy is a well-described technique
for repair and replacement of mitral valves. It provides reduced
post-operative pain, decreased infection, improved cosmesis, and reduced
length of stay.4 For repair of CTS, it provides
excellent exposure of the left atrium allowing for complete assessment
of the pulmonary veins, left atrial appendage and the CTS membrane. This
is only the second reported case of minimally invasive repair of CTS in
the literature to our knowledge. 5 We believe that
minimally invasive anterolateral thoracotomy should be the preferred
method for treatment of CTS as well as other left atrial and mitral
pathology.
Conflicts of Interest :
There are no conflicts of interest