Surgical Treatment of Atrial Myxomas: Outstanding Outcome of a Treacherous Tumor

Hosain, Nazmul; Chowdhury, Muhammad Abdul Quaium; Maruf, Mohammad Fazle; Chowdhury, Minhazur Rahman; Barua, Subir; Rahman, Mohammad Masudur

doi:10.1016/j.cjco.2020.10.021

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…The rate of reoperations was low, with 2.0% after 24 years[ 4 ]. In a recently published small study from Bangladesh, all 20 patients with cardiac myxoma survived the surgery, and 1 patient presented with recurrence 28 mo after the surgery[ 111 ]. In recent years, cardiac myxomas have been excised successfully by minimally invasive surgery with or without robotic assistance[ 119 - 122 ].…”

Section: Treatmentmentioning

confidence: 99%

Cardiac myxomas: A narrative review

Islam¹

2022

WJC

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Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.

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Section: Treatmentmentioning

confidence: 99%

Cardiac myxomas: A narrative review

Islam¹

2022

WJC

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“…The Rutherford ALI classification in table 1 divides an extremity into three categories: viable, threatened or irreversibly damaged 36. For patients with viable (stage I), marginally threatened (stage IIa) and immediately threatened limbs (stage IIb), Doppler ultrasound should be readily available to aid in prompt revascularisation and guide management 14. All patients with ALI are initially managed with intravenous heparin to prevent recurrent embolism and clot propagation, except when contraindications are present 37…”

Section: Discussionmentioning

confidence: 99%

“…TTE had a sensitivity of 95%, whereas TEE had a sensitivity of 100%. MRI and CT can help detect recurrence 14…”

Section: Outcome and Follow-upmentioning

confidence: 99%

Embolism from a left ventricular myxoma presenting with acute limb ischaemia

Billones,

Imperial,

Gutierrez-Cayetano

2023

BMJ Case Rep

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Acute limb ischaemia (ALI) secondary to cardiac myxoma is uncommon. Embolic myxoma should be considered a differential diagnosis in young patients with ALI who do not have apparent cardiovascular risk factors. A multidisciplinary approach and comprehensive care can improve outcomes and optimise the collaborative treatment of ALI. Early referral to a hospital that can provide specialised treatment for ALI helps prevent significant tissue loss and surgical complications, such as amputation.A man in his 20s presented with bilateral ALI of both lower extremities, and an arterial duplex scan revealed a thrombus occluding all arterial segments of the bilateral lower extremities. An intracardiac mass adherent to the apical and anterior interventricular septum on two-dimensional echocardiography suggested a complex myxoma. The patient was diagnosed with ALI Rutherford category III, and bilateral hip disarticulation was performed. The patient was discharged with an anticoagulant.

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“…9 Since then, many centers have reported their outcomes after cardiac tumor resection. [10][11][12] Traditionally, the operation is performed via sternotomy or thoracotomy. Recently, robotic cardiac surgery (RCS) has increased in popularity and use both in the United States and abroad due to its appealing minimally invasive approach.…”

Section: Introductionmentioning

confidence: 99%

“…The first successful myxoma resection was performed by Swedish cardiac surgeon Clarence Crafoord in 1954 9 . Since then, many centers have reported their outcomes after cardiac tumor resection 10–12 . Traditionally, the operation is performed via sternotomy or thoracotomy.…”

Section: Introductionmentioning

confidence: 99%

Routine endoscopic robotic cardiac tumor resection using an 8‐mm working port and percutaneous cannulation

Rosen

Yost

Wong

et al. 2022

Journal of Cardiac Surgery

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Objective Prior studies have demonstrated robotic excision of cardiac tumors as a safe and effective treatment option. The procedure is performed with five incisions: three robotic arm ports, one atrial retractor port, and one working port. We report our unique initial experience in robotic tumor removal. To our knowledge, this is one of the first reports demonstrating cardiac myxoma and fibroelastoma removal with use of exclusively 8‐mm ports. Methods All data for robotic cardiac tumor resection at our institution from June 2019 to December 2021 were retrospectively collected; 18 cases were included, including 13 cardiac myxomas and five fibroelastomas. Baseline demographics, intraoperative characteristics, and surgical outcomes were recorded. Descriptive statistics were calculated; continuous variables were reported as median [interquartile range], and categorical variables were reported as percentages. Results Median patient age was 64 [55, 70] years old. The cohort consisted of primarily female (67%) and white (83%) patients. Median body mass index was 26.3 [23.0, 31.5] kg/m2. 11% of patients were current tobacco users and 50% had hypertension. All patients underwent myxoma or fibroelastoma removal with the use of five 8‐mm robotic ports. Each patient underwent percutaneous cannulation via the femoral arteries. Aortic occlusion was achieved via an endoaortic balloon (67%) or transthoracic cross‐clamp (33%). Cross‐clamp time was 30 [26, 41] minutes. Concomitant procedures performed during myxoma removal included patent foramen ovale closure (28%), mitral valve repair (8%), left atrial appendage closure (8%), Cox‐maze procedure (6%), and coronary artery bypass grafting (6%). All cardiac tumors were packaged with use of the endo‐bag and subsequently removed through the working port. Maximal myxoma and fibroelastoma diameters were 2.5 [1.7, 3.5] and 0.6 [0.4, 0.7] cm, respectively. Procedural cardiopulmonary bypass time was 77 [65, 84] minutes. No intraoperative mortality, reoperation for bleeding, or postoperative cardiac issues were recorded. One in‐hospital mortality occurred as the result of a thrombotic event in the context of a hypercoagulable state unrelated to the patient's operation. No other mortalities were observed at 30 days. Hospital length of stay was 4.5 [3.0, 7.8] days. Conclusions In our study, the robotic platform facilitated safe and effective cardiac tumor excision. Our results highlight the efficacy of 8‐mm port sizing and the concurrent use of other minimally invasive techniques, including percutaneous cannulation, in this patient population. In general, patients prefer the least invasive treatment option available. Our findings emphasize the importance of training cardiac surgeons to perform robotic procedures using the least invasive means possible to provide patients with various options for their treatment.

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Surgical Treatment of Atrial Myxomas: Outstanding Outcome of a Treacherous Tumor

Cited by 6 publications

References 33 publications

Cardiac myxomas: A narrative review

Cardiac myxomas: A narrative review

Embolism from a left ventricular myxoma presenting with acute limb ischaemia

Routine endoscopic robotic cardiac tumor resection using an 8‐mm working port and percutaneous cannulation

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