Clinical Features and Surgical Treatment of Cardiac Myxoma: Report of 18 Cases

Abstract

Myxomas are the most common benign primary cardiac tumors. As many patients with cardiac myxoma suffer from cerebral or systemic embolism, which are serious complications, diagnosis of the tumor is vital. Between 1990 and 2000, 18 patients (6 males, 12 females), aged 24 to 73 years (mean, 55.3 years), were operated on for cardiac myxoma. The most common location of the myxoma was the left atrium (78%), and the transseptal surgical approach was preferred (78%) as it allows total resection of the left atrial myxoma along with its pedicle. Carney complex, a familial autosomal dominant form of atrial myxoma, was not found in any of the patients. There had been no operative or postoperative mortality and morbidity. The mean postoperative follow-up period was 5 years (mean, 1 to 10 years). No recurrence had been seen. We believe that the transseptal approach, in allowing total resection of the myxoma, prevents recurrence.

The Challenge Presented by Right Atrial Myxoma

“…Several separate familial cardiac myxoma syndromes constitute up to 10% of all myxomas -the present metaanalysis disclosed an incidence of 4.5% [8,23,30] -and can demonstrate multiple atypical locations [58]. The most common syndrome, the Carney complex (CNC), is an autosomal dominant multiple endocrine neoplasia and lentiginosis syndrome, characterized by cardiac myxomas, spotty skin pigmentation by multiple blue naevi and lentigines (68%), skin myxomas (40%) and breast fibroadenoma (27%), and a variety of endocrine and other tumors, particularly adrenal cortical disease (37%) and testes tumors (34%).…”

“…Of a population of 644 patients, 64.6% were female and 35.4% male [2,7,8,15,31,32,37,47,52,57,59,65,70,71,73,78,80]. Three studies with a cumulative total of 154 individuals report an overall fraction of familial cardiac myxomas of 4.5% within a range from 0 to 5.7% [8,23,30].…”

“…Surgery in the form of complete tumor excision by limited septectomy with a wide margin of tissue [39,59] is safe and represents the gold-standard treatment: clinical short-term and longterm results are excellent [8,22,23], and actuarial 15-to 20-year survival is reported to range between 85% and 92% [11,65]. However, close clinical follow-up by echocardiography for at least 10 years may be required to rule out recurrence [59].…”

Myocardial infarction as complication of left atrial myxoma

“…One patient [7] suffered distal aneurysm, although the coronaries were otherwise free. Only distal occlusion of a vessel was found in 4 patients [15,27,39,62]. In contrast, occlusion of one of the large coronaries was mostly found when coronary angiography was performed immediately [20,57,60,71].…”

A Case of Multi-System Signs and Symptoms Unified Under the Diagnosis of Atrial Myxoma

“…Cardiac obstructive symptoms are typically due to the tumor's position resulting in mitral valve obstruction, with findings similar to severe mitral stenosis (dyspnea on exertion, orthopnea, syncope, or, in the case of complete obstruction, sudden death) (1,5,6). Dysrhythmias are rare, being seen in only 9% of patients in one review (5).…”