Long-term follow-up of atrial myxoma.

Abstract

Experience of I2 patients with atrial myxoma over a period of Io years is reviewed. Eleven patients had a left atrial tumour and one a right atrial tumour.Successful surgical removal was carried out in 9 (8 left, and I right). Three patients died before operation, the diagnosis having been made in life in 2 of them.Seven patients with left atrial myxoma have been followed for 5 to Io years after operation. Two died after 4 and 6 years, respectively, from probable neoplasia of the lungs without evidence of a recurrence of the myxoma.All the remaining 5 patients are well and without any evidence of recurrence, apparently having been cured of the condition.Angiocardiography and cardiac catheterization in 4 patients revealed relief of left atrial and pulmonary arterial hypertension. There was no evidence of a space-occupying lesion in the left atrium.The importance of early diagnosis and surgical treatment is stressed, and the advisability of removing part of the atrial septum surrounding the tumour is commented upon. The value of echocardiography in establishing the diagnosis, and thus avoiding the necessity for angiography, is discussed. It is concluded that though recurrence, which has been reported in 2 cases, is rare, regular follow-up is advisable.Atrial myxoma is the commonest primary cardiac tumour (Leach, I947). The features of left atrial obstruction, systemic embolism, and systemic illness are now well known and the profile of the disorder was reviewed by Greenwood (I968).In i962, we (Goodwin et al.) reported our initial experience in the diagnosis and management of 4 patients with left atrial myxoma, 3 of whom came to successful surgical treatment.We now review the fate of I2 patients with atrial myxoma over a period of ii years, with emphasis on the long-term results of surgical treatment. PatientsThree patients died before operation. In the first the diagnosis was not made until necropsy, the significance of the association of severe pulmonary hypertension, signs suggesting mitral valve disease, haemolytic anaemia, and fever not having been appreciated (McGregor and Cullen, I959).The second patient who was reported in I962Received 30 December I971.(Goodwin et al.) was diagnosed, but died before operation. The third patient was admitted in extremis as a result of left atrial obstruction, and died after diagnostic investigation.Of the remaining 9 patients, 8 had a left and one a right, atrial myxoma. The tumour was successfully removed in all. The patient with the right atrial myxoma (Case 6) was a girl of I7 years, diagnosed and referred for operation by Dr. Ian Gray of Coventry. The clinical and angiographic features were characteristic (Barlow, Fuller, and Denny, x962) and the postoperative course has been uneventful. There are now no abnormal signs, and angiography is normal.

The modern diagnosis of cardiac myxoma: Role of two‐dimensional echocardiography

“…John Sutton et al, 1980;Walton et al, 1972). Although one patient in the Mayo Clinic study (St. John Sutton et al, 1980) required mitral valve replacement, severe damage of the atrioventricular valves in myxoma is rare (Croxson et al, 1972). The mitral insufficiency in our two patients remained mild on follow-up.…”

“…The only late complications were residual mitral insufficiency in 2 patients (20%), associated with recurrence of a LAM in one (1 0%). The few long-term follow-up studies of myxoma have also found a similar, 5-14% incidence of recurrent LAM (Bulkley and Hutchins, 1979;Croxson et al, 1972;Richardson et al, 1979;St. John Sutton et al, 1980).…”

“…Major surgery with cardiopulmonary bypass is required. Prior to surgery, the patients are prone to pulmonary or systemic embolism (Goodwin, 1963), pulmonary hypertension (Croxson et al, 1972), congestive heart failure with hepatic dysfunction and deranged plasma globulins (Goodwin, 1963(Goodwin, , 1968. Such factors might contribute to postoperative problems.…”

“…Since prompt surgical removal offers potential cure, there is a need for improved methods of early detection (Bulkley and Hutchins, 1979;Goodwin, 1963Goodwin, , 1968. Although echocardiography (echo) has facilitated the noninvasive diagnosis of cardiac myxoma (Come et al, 1981;Harbold and Gan, 1973;Lappe et al, 1978;Nasser et al, 1972;Wolff et al, 1969), cases are still missed or diagnosed late (Croxson et al, 1972;St. John Sutton et al, 1980).…”

Atrial myxoma: a review of the neurological complications, metastases, and recurrences

“…Since then 17 cases with 20 recurrences have been reported (Gerbode et al, 1967;Bahl et al, 1969;Kelly and Bhagmat, 1972;Walton et al, 1972;Maramhao et al, 1973;Read et al, 1974;Jugdutt et al, 1975;Dang and Hurley, 1976). However, results of only a few long-term studies of atrial myxoma cases have been published (Croxson et al, 1972;Hardin et al, 1974;Hedfors and Mogensen, 1974). Reviewing 12 cases of recurrent atrial myxomas, Read et al (1974) found that the average time to reoperation was only 31 months.…”