Should we perform preoperative coronary angiography in all cases of atrial myxomas?

Abstract

The prevalence of coronary disease is high in patients with atrial myxomas yet routine angiography is not performed. Moreover, some tumors have angiographically detectable neovascularity, which can alter surgical planning. We report two cases that support our recommendation for performing coronary angiography in all cases diagnosed with cardiac myxomas.

Left atrial myxoma with neovascularization: detected on cardiac computed tomography angiography

“…Nevertheless, some authors have suggested that coronary angiography should be performed routinely in patients with cardiac myxoma so as to detect the presence of a large supplying vessel [6]. Other authors have suggested that coronary angiography should only be performed in the case of selected patients, particularly those over the age of 40 years and those with atherosclerotic risk factors undergoing surgical removal of a cardiac mass [4].…”

Right atrial myxoma with tumor vascularity originated from the left and right coronary arteries

“…In the literature, coronary angiography in patients with cardiac myxomas was recommended to exclude concomitant coronary artery disease and to clarify the origin of tumor vascularity [6,7]. And in most case, neovascularization revealed by coronary angiography and even by echocardiography, CT, or MRI suggests cardiac malignancy.…”

Systematic Review and Meta-analysis of Prevalence of Coronary Artery Disease in Adult Patients with Cardiac Myxomas

“…There is little documented literature on the relationship between CAD and cardiac myxomas 8 . This article provides the first compilation of available angiographic data on adult patients with cardiac myxomas and CAD.…”

“…Actually, even patients without any risk factors can present with CAD 25 . Therefore, others suggest that all adult patients diagnosed with myxomas should undergo CA 5, 8, 18, 25, 26 . In fact, preoperative CA seems to be quite safe; thus far there has been no report of procedure-related complications 8, 16, 18, 24– 27 .…”

“…In addition, transesophageal echocardiography (TEE), cardiac magnetic resonance (MRI) and ultrafast computed tomography (CT) have also proved their usefulness in diagnosis 8, 9 .…”