The problems of surgical treatment for cardiac myxoma and associated lesions

Abstract

Twenty-four patients with cardiac myxomas consisting of 22 left and 2 right atrial myxomas were operated on. All myxomas were removed with an excision of the attachment walls using a cardiopulmonary bypass. Two myxomas required a partial cardiopulmonary bypass from the femoral vein to the artery prior to operation because they were on the verge of becoming stuck in the atrioventricular valves and potentially causing shock. For embolic complications of myxoma, the embolus of the external carotid artery was extirpated before undergoing cardiac surgery. In a patient with pulmonary infarction, the infarcted lung was resected simultaneously. Another patient with a cerebral infarction received a clipping of an aneurysm which later appeared in the infarcted area. For associated cardiac lesions, two patients underwent a coronary artery bypass graft and one mitral valve replacement with tricuspid annuloplasty. In the former two cases, the myxoma was removed prior to coronary artery bypass grafting because the use of retrograde coronary perfusion was considered to be sufficient to protect the heart. In the latter case, the removal of the myxoma first disclosed a significant mitral lesion which had been masked by the huge myxoma. All patients but one, who died of pneumonia, showed a good recovery. In this series, the problems of surgical treatment for cardiac myxoma and associated lesions are also discussed.

The Challenge Presented by Right Atrial Myxoma

“…The age of all reported individuals varied much more extensively: between 1 month and 81 years. 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].…”

An Atypical Giant Right Atrial Myxoma Presented with Minimal Symptoms

“…Complete resection of the tumor and its implantation base with a good safety margin is essential to cure the disease. The survival rate after surgery is elevated [14][15][16].…”

Atrial myxoma with coexistent coronary artery disease: A report of two cases

“…Seventy‐five per cent of cardiac myxomas originate in the left atrium and 18% in the right atrium 1 . Adult patients with cardiac myxomas may have additional cardiac pathology, the commonest being mitral valve disease 2 . Left atrial myxomas may embolise to the coronary artery resulting in acute myocardial infarction 3,4 .…”

“…However, Sugimoto et al . used retrograde coronary perfusion for myocardial protection and excised the myxoma before coronary artery bypass grafting 2 . Ostensibly, minimal cardiac manipulation prior to complete resection of the tumour minimises the risk of embolisation.…”