Operative management and outcomes in patients with myxomas: A single-center experience

Background

Cardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma.

Method

This study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection.

Result

The mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%.

Conclusion

Recurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality.

Left atrial myxoma presenting as acute inferior wall infarction-a case report

Acute myocardial infarction is a rare form of presentation in patients with left atrial myxoma. With wider availability of echocardiography, more and more patients with atrial myxomas will be diagnosed. This report describes a patient with left atrial myxoma who presented features of acute myocardial infarction and had surgical removal of LA myxoma.

Surgical Management of Cardiac Myxoma

OBJECTIVE

Between 1994 and December 2003, 55 patients were operated for cardiac myxoma in Kosuyolu Heart and Research Hospital in Istanbul.

METHODS

We retrospectively analyzed our results according to the preoperative characteristics, operative procedures, and postoperative courses.

RESULTS

Of 55 patients operated, 36 (65.4%) were female and 19 (34.6%) male. The average age of the patients was 48 +/- 15.5 years (range, 12-75). Thirteen patients (23.6%) previously had cerebrovascular accidents. Peripheral arterial emboli had occurred in 11 (20%) patients. The majority of the patients (44.4%) were in NYHA Class II preoperatively. One patient was presented with Carney's complex. Most frequent location was the left atrium (85.2%). Eight patients had concommitant surgery together with myxoma extirpation. Postoperative courses were uneventful. Three patients had a new onset atrial fibrillation, two had transient conduction disturbances. There were two (3.6%) in-hospital deaths. No recurrences have been noted during the 82.4 +/- 40.6 months (a total of 315.75 patient/years) follow-up.

CONCLUSIONS

Surgical management of cardiac myxoma gives excellent results. In selected cases, a conservative approach may be adequate. Despite the scarcity of the neoplastic properties, careful follow-up is necessary.