1
|
Peng X, Xiao Y, Guo Y, Zhu Z, Liao L, Liao X, Hu X, Fang Z, Li X, Zhou S. Clinical Significance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Myxomas are the most common primary cardiac tumors. Angiographically detectable neovascularity (ADN) of myxoma is increasingly being reported as a result of the use of coronary angiography (CAG) to detect coronary artery disease. However, the clinical significance
of these findings is not fully understood.Methods: We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018. Patients were followed up for a mean of 28.9 months (range 1‐69 months). The clinical features, echocardiography measurements,
pathological examination findings, CAG results, and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results: ADN was found in 25 patients (42.4%). The arteries feeding the ADN included the right coronary artery (n=15), the left circumflex
coronary artery (n=7), and both arteries (n=3). The patients with ADN had a higher proportion of eosinophils (3.2% vs. 2.2%, P=0.03) and higher low-density lipoprotein cholesterol level (2.7 mmol/L vs. 2.2 mmol/L, P=0.02). Myxoma pedicles were more likely to be located in the
interatrial septum in patients with ADN (96% vs. 73.5%, P=0.02). No significant correlation was observed between the groups in clinical manifestations, atrial arrhythmia, myxoma size, cardiac chamber size, left ventricular ejection fraction, and the prevalence of complication with coronary
artery disease [16% in the ADN group (n=4) vs. 20.6% in the non-ADN group (n=7), P=0.66]. However, patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up (0% vs. 14.7%, P=0.07).Conclusion: CAG-detected
ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.
Collapse
Affiliation(s)
- Xiaofan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanan Guo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaobo Liao
- Department of Cardiovascular and Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
2
|
Velasco CE, Suarez NP, Roullard CP, McCullough PA, Roberts WC. Usefulness of coronary angiography in patients with left atrial myxoma. Proc (Bayl Univ Med Cent) 2020; 33:529-531. [DOI: 10.1080/08998280.2020.1776024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Carlos E. Velasco
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- College of Medicine, Texas A&M Health Science Center Dallas Campus, Dallas, Texas
| | | | | | - Peter A. McCullough
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- College of Medicine, Texas A&M Health Science Center Dallas Campus, Dallas, Texas
| | - William C. Roberts
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- College of Medicine, Texas A&M Health Science Center Dallas Campus, Dallas, Texas
| |
Collapse
|
3
|
Lee SY, Lee SH, Jung SM, Choi JH, Chon MK, Hwang KW, Kim JS, Park YH, Kim JH, Chun KJ, Je HG, Park JS. Value of Coronary Angiography in the Cardiac Myxoma. Clin Anat 2019; 33:833-838. [PMID: 31749186 DOI: 10.1002/ca.23527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/15/2019] [Indexed: 11/08/2022]
Abstract
Preoperative coronary angiography for cardiac myxoma not only excludes coronary artery disease but also detects the artery feeding the cardiac myxoma, which has several clinical implications. In this study, we examined cardiac myxoma cases in two tertiary hospitals using coronary angiography to identify the artery feeding the myxoma. We retrospectively reviewed 42 patients with cardiac myxoma who had undergone surgical removal between July 2008 and December 2015 in two tertiary hospitals, and recorded their baseline characteristics, echocardiographic findings, and coronary angiography. Among those 42 patients, 23 (55%) had coronary angiography before surgery and in no case was significant luminal narrowing observed. In 21 of the coronary angiograms, the artery feeding the cardiac myxoma had a vascular branch (100%), clusters of tortuous vessels with contrast medium pooling (67%), an arteriocavity fistula (33%), and a mobile feeding artery (67%). No significant relationship was found between coronary artery dominance type and the origin of the artery feeding the cardiac myxoma (P = 0.362). Identification of the artery feeding the cardiac myxoma, with a distinctive vascular appearance in coronary angiography, is important for several clinical applications such as helping to diagnose cardiac myxoma and to plan the surgical approach. Clin. Anat. 33:833-838, 2020. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Soo Yong Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soon Myung Jung
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin Hee Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min Ku Chon
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jeong Su Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong Hyun Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyung Gon Je
- Department of Cardiovascular and Thoracic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin Sup Park
- Department of Cardiology, Pusan National University Hospital, Busan, Republic of Korea
| |
Collapse
|
4
|
Nazir T, Ahmed S, Ahmed IM. Left atrial myxoma: an unusual cause of postpartum tachycardia and shortness of breath. BMJ Case Rep 2019; 12:12/9/e231283. [PMID: 31527217 DOI: 10.1136/bcr-2019-231283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary cardiac tumours are exceedingly rare in clinical practice and a myxoma is certainly not the first suspected diagnosis on a list of differentials in a patient presenting with breathlessness and tachycardia. Naturally, a structured work-up to rule out much more common conditions will take place. Nonetheless, an index of clinical suspicion is required especially when a clear-cut diagnosis is not forthcoming. We describe a case of a postpartum woman who presented with shortness of breath and palpitations, and was eventually diagnosed with a left atrial tumour. She underwent a successful surgical excision of the mass which was found to be a myxoma on histological examination. We review and present an up-to-date literature review on epidemiology, pathophysiology, clinical features, diagnosis and treatment options for cardiac myxomas.
Collapse
Affiliation(s)
- Tahir Nazir
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Saad Ahmed
- Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Irfan Munir Ahmed
- Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| |
Collapse
|
5
|
Balci AY, Sargin M, Akansel S, Ünal Dayi S, Kuplay H, Mete ME, Orhan G, Aykut Aka S. The importance of mass diameter in decision-making for preoperative coronary angiography in myxoma patients. Interact Cardiovasc Thorac Surg 2019; 28:52-57. [PMID: 30010840 DOI: 10.1093/icvts/ivy217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although coronary angiography (CAG) is generally performed to rule out coexisting coronary artery disease in patients with cardiac myxoma, its necessity to evaluate vascular supply of the myxoma is debatable. The aim of this article is to evaluate clinical experience and CAG findings in our patient group. METHODS This retrospective analysis was performed in 46 patients (17 men, mean age 57.7 ± 8.6 years), who underwent surgery with an indication for cardiac myxoma between 2004 and 2016 with a CAG performed preoperatively. All CAGs were evaluated in a blinded manner by a cardiac surgeon and a cardiologist separately. Correlations between the presence and pattern of feeding vessels, presence of an arteriocavity fistula (ACF), coronary arterial dominance, size of mass and clinical presentations were analysed. RESULTS Coronary artery disease defined as >50% obstructive lesions was detected in 10 patients (21.7%). The tumour diameter was found to be significantly higher in patients who had an ACF and a dual-feeding artery (P = 0.049 and P = 0.0001, respectively). Additionally, there was a significant relationship between the presence of dual-feeding vessels and ACF (P = 0.014). ROC analysis revealed a cut-off point of 27 mm in diameter based on the presence of an ACF and a dual-feeding artery. In cases with a diameter of 27 mm or above, the risk of existence of an ACF was 4.68-fold greater, with a confidence interval of 95%, and a dual-feeding pattern was seen in all of them. CONCLUSIONS This study suggests that preoperative CAG can be considered to detect feeding vessels that may lead to a steal phenomenon, which may alter the management in patients with myxoma greater than 27 mm in diameter.
Collapse
Affiliation(s)
- Ahmet Yavuz Balci
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Murat Sargin
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Serdar Akansel
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Sennur Ünal Dayi
- Department of Cardiology, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Hüseyin Kuplay
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Müge Evren Mete
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Gökçen Orhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Serap Aykut Aka
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Jung HW, Doh JH, Chang WI. Multi-modality imaging of a left atrial myxoma. SAGE Open Med Case Rep 2017; 5:2050313X17736230. [PMID: 29123666 PMCID: PMC5661666 DOI: 10.1177/2050313x17736230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/18/2017] [Indexed: 11/15/2022] Open
Abstract
Objectives Although echocardiography has traditionally been used to diagnose myxoma, invasive or non-invasive coronary angiography can be useful diagnostic tool before surgery. Methods We present a case of an angiographically detected left atrial myxoma feeding from the left circumflex coronary artery. Results The patient underwent open-heart surgery to remove the left atrial myxoma. After ligation of feeding artery, the mass was successfully excised. Conclusion Preoperative coronary angiography can offer additional valuable information moreover detecting coronary artery disease. Because, there is sudden death risk from embolization during invasive coronary angiography, preoperative cardiac computed tomography angiography should be considered to plan the surgery of myxoma.
Collapse
Affiliation(s)
- Hae Won Jung
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Korea
| | - Joon Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Korea
| | - Woo-Ik Chang
- Department of Thoracic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Korea
| |
Collapse
|
7
|
Silva M, Carneiro M, Nunes J, da Silva A, de Sousa M. Systematic Review and Meta-analysis of Prevalence of Coronary Artery Disease in Adult Patients with Cardiac Myxomas. F1000Res 2015; 4:194. [PMID: 28620449 PMCID: PMC5461895 DOI: 10.12688/f1000research.6641.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Studies have reported varied prevalence estimates of coronary artery disease (CAD) in cardiac myxoma patients. We performed a systematic review and meta-analysis of observational studies to summarize the point prevalence of CAD in adults with cardiac myxomas. Methods and Results: Two independent investigators searched MEDLINE and LILACS databases using the terms " Myxoma", " Coronary Angiography" and " Coronary Disease" from inception through December 2014 for all relevant studies. We included 6 observational studies. Publication bias was evaluated through Egger's test and Trim and Fill method. A pooled estimate of CAD prevalence with corresponding 95% confidence interval (CI) was calculated based on a random-effects model. The pooled CAD prevalence in adult cardiac myxoma patients was 20.7% with low heterogeneity (I 2 = 14.86%). Conclusions: It is a matter of debate if preoperative coronary angiography must be done as a routine procedure. Although coronary disease and angiographically detectable neovascularity can alter surgical management, more studies are needed to evaluate this question.
Collapse
Affiliation(s)
- Matheus Silva
- Inteventional Cardiology Department, Hospital Universitário Ciências Médicas, Belo Horizonte, 30140-073, Brazil
| | - Matheus Carneiro
- Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil
| | - Júlio Nunes
- Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil
| | - Antônio da Silva
- Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil
| | - Marcos de Sousa
- Post Graduation Program in Adult Health Sciences and Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
8
|
Kim JG, Moon D, Yi JE, Youn HJ, Kim DW, Park GS, Lee KY, Chang M. Recurrent cardiac chloroma presenting as acute chest pain. QJM 2014; 107:381-2. [PMID: 24282312 DOI: 10.1093/qjmed/hct238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J G Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, Seoul, Korea.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Omar HR. The value of coronary angiography in the work-up of atrial myxomas. Herz 2013; 40:442-6. [PMID: 24173374 DOI: 10.1007/s00059-013-3930-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/02/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022]
Abstract
Atrial myxomas are the most common primary cardiac tumors. They are highly vascular with evidence of neovascularization and a characteristic"tumor blush" in approximately half of the cases. Although the visualization of feeding vessels has several clinical and therapeutic implications, there is still no consensus on the indication of preoperative coronary angiography to assess tumor vascularity except in patients with angina or those older than 40 years to rule out coronary artery disease. Herein, I present a case of an incidentally discovered right atrial mass receiving vascular supply from the right coronary artery. The mass was successfully excised and the diagnosis of cardiac myxoma was confirmed via histopathology. A review of the value of coronary angiography in detecting myxoma neovascularization is provided, which suggests that it can offer additional valuable information that can alter the surgical approach and therefore may be considered prior to myxoma resection.
Collapse
Affiliation(s)
- H R Omar
- Internal Medicine Department, Mercy Hospital and Medical Center, 2525 South Michigan Avenue, 60616, Chicago, Illinois, USA,
| |
Collapse
|
10
|
Umeda Y, Matsuno Y, Imaizumi M, Mori Y, Iwata H, Takiya H. Right atrial myxoma with tumor vascularity originated from the left and right coronary arteries. Int J Cardiol 2009; 131:e137-9. [PMID: 17961762 DOI: 10.1016/j.ijcard.2007.07.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 07/02/2007] [Indexed: 11/27/2022]
|