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Okan T, Babliak O, Agarwal K, Kuzyk Y, Lanka SP, Iskander B, Sharma S, Tadepalli S, Jaiswal R, Hussain A, Rashid MY, Chakinala RC. Asymptomatic Left Atrial Myxoma Treated With Minimally Invasive Surgical Approach. Cureus 2021; 13:e18432. [PMID: 34737901 PMCID: PMC8559889 DOI: 10.7759/cureus.18432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Myxomas, being the most common primary benign tumor among all cardiac tumors, occur rarely with a very low incidence rate. Myxomas can cause various clinical manifestations or can be diagnosed incidentally. Some patients with cardiac myxomas are completely asymptomatic. Cardiac myxomas cause life-threatening complications, thus early diagnosis is imperative. We are reporting a case of atrial myxoma in a 38-year-old female without any significant past medical history, who came to our clinic for cardiology evaluation prior to plastic surgery. The elliptical mobile mass, located in the left atrium with its attachment to the interatrial septum, was diagnosed by transthoracic echocardiography. The patient was referred for surgery and a minimally invasive surgical approach was chosen. A histological report confirmed the diagnosis of myxoma. The patient recovered well. Three years of follow-up did not reveal any signs of recurrence of the tumor. We are also analyzing 20 previously published cases of asymptomatic myxomas and myxomas treated with a minimally invasive surgical approach, reported in the PubMed database for the last 20 years (2001-2021) in the adult patient population (age 19 and over). The aim of this study is to highlight the asymptomatic presentation of cardiac myxomas and to underline the advantages of a minimally invasive surgical approach. In summary, asymptomatic cardiac myxomas are rare incidental findings. Attention to subtle symptoms during a physical exam and scrupulous history-taking can provide a clue to this diagnosis. Early diagnosis of cardiac myxomas is crucial to prevent life-threatening complications. Minimally invasive surgery is a promising alternative approach to standard open-heart surgery for treating cardiac myxomas, providing faster recovery and higher patient satisfaction with surgical care.
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Affiliation(s)
- Tetyana Okan
- Department of Diagnostic Imaging, The Metropolitan Andrey Sheptytsky Hospital, Lviv, UKR
| | - Oleksandr Babliak
- Department of Cardiac Surgery, Cardiac Surgery Center "Dobrobut", Kyiv, UKR
| | - Kriti Agarwal
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Yulia Kuzyk
- Department of Pathological Anatomy and Forensic Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Beshoy Iskander
- Department of Internal Medicine, Bon Secours Mercy Health- St. Elizabeth Youngstown Hospital (NEOMED), Youngstown, USA
| | - Sanjeev Sharma
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA
| | - Satish Tadepalli
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Richa Jaiswal
- Department of Pathology, Medical University of South Carolina, Charleston, USA
| | - Akbar Hussain
- Department of Internal Medicine, Keystone Health System, Chambersburg, USA
| | - Mohammed Y Rashid
- Department of General Surgery, University of Illinois -MGH, Chicago, USA
| | - Raja Chandra Chakinala
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA.,Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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Hua K, Zhao Y, Dong R, Liu T. Minimally Invasive Cardiac Surgery in China: Multi-Center Experience. Med Sci Monit 2018; 24:421-426. [PMID: 29353871 PMCID: PMC5788050 DOI: 10.12659/msm.905408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To the best of our knowledge, there is no nationwide data available on the development of minimally invasive cardiac surgery (MICS) in China. The purpose of this study was to report the results of MICS in 6 experienced centers in China. MATERIAL AND METHODS From September 2014 to July 2016, 1241 patients with cardiac conditions who underwent MICS procedures were randomly enrolled in 6 centers in China, and those patients were randomly selected for inclusion in this study. The MICS procedures were defined as any cardiac surgery performed through a less invasive incision, rather than a complete median sternotomy, mainly including mini-incision surgery (400, 32.2%), video-assisted approach (265, 21.3%), completely thoracoscopic approach without robotic assistance (504, 40.6%), and robotic procedure (55, 4.4%). RESULTS The 5 most common in-hospital complications were respiratory failure (28, 2.3%), reoperation for all reasons (19, 1.5%), renal failure (11, 0.9%), heart failure (9, 0.7%), and stroke (6, 0.5%). The multivariate logistic regression analysis results showed that cardiopulmonary bypass (CPB) time (P=0.033), aortic cross-clamp time (P=0.003), cannulation approach (P=0.010), and left ventricular ejection fraction (LVEF) (P=0.003) at baseline were all significant risk factors of any in-hospital complication of MICS procedures. CONCLUSIONS From our experience, minimally invasive cardiac approaches are safe and reproducible, with acceptable CPB and aortic cross-clamp time duration and low mortality.
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Affiliation(s)
- Kun Hua
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yang Zhao
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
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Soylu E, Kidher E, Ashrafian H, Stavridis G, Harling L, Athanasiou T. A systematic review of left ventricular cardio-endoscopic surgery. J Cardiothorac Surg 2017; 12:41. [PMID: 28545585 PMCID: PMC5445499 DOI: 10.1186/s13019-017-0599-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 05/10/2017] [Indexed: 11/24/2022] Open
Abstract
Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique. There were no mortalities (0%; 0/47). In 12 studies, the follow-up period was longer than 30 days. There were no post-operative complications apart from one case of atrial fibrillation (2.2%; 1/46). Complete resection of left ventricular lesion was achieved in all cases (100%; 50/50). These successful results demonstrate that the cardio-endoscopic technique is a useful adjunct in resection of left ventricular tumours, thrombus and hypertrophic myocardium. This approach facilitates accurate resection of pathological tissue from left ventricle whilst avoiding exposure related valvular damage and adverse effects associated with ventriculotomy. Future research should focus on designing adequately powered comparative randomised trials focusing on major cardiac and cerebrovascular morbidity outcomes in both the short and long-term. In this way, we may have a more comprehensive picture of both the safety and efficacy of this technique and determine whether such devices could be safely adopted for routine use in minimal access or robotic intra-cardiac surgery.
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Affiliation(s)
- Erdinc Soylu
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - Emaddin Kidher
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - George Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, UK.
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Kourkoveli P, Tsiapras D, Grisbolaki E, Karapanagiotou O, Kampanarou S, Kyrzopoulos S, Kaklamanis L, Khoury M, Voudris V. Growth rate of an apical left ventricular myxoma using serial two dimensional echocardiographic and computed tomography observations over twelve months: a case report. J Med Case Rep 2014; 8:60. [PMID: 24548464 PMCID: PMC3943379 DOI: 10.1186/1752-1947-8-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/14/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Myxomas are the most common benign tumors of the heart. They vary widely in size, and little is known about their growth rate. The present case report is, we believe the first in bibliography that provides images of an apical left ventricular myxoma from transthoracic echocardiography and computed tomography scans taken a year apart. CASE PRESENTATION We present the rare case of a 65-year-old asymptomatic Caucasian man with an apical left ventricular myxoma that grew over a 12-month period. Our patient underwent successful surgical excision of the tumor and had an uneventful postsurgical recovery period. CONCLUSIONS Left ventricular myxomas are benign and curable tumors. They do not usually present with systemic symptomatology and most of them are diagnosed as sequelae of syncope caused by left ventricular outflow tract obstruction or systemic embolization. Because they are usually removed after diagnosis, the growth rate of myxomas is generally unknown. We present a rare case of the asymptomatic presentation of a left ventricular myxoma and its documented growth during a 12-month period.
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Affiliation(s)
- Panagiota Kourkoveli
- Department of Cardiology, Onassis Cardiac Surgery Center, 8 Iasiou Street, 11521 Athens, Greece.
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