Cardiac Myxomas: A Single Center Experience with 33 Cases

Review Article

Austin J Surg. 2020; 7(4): 1253.

Cardiac Myxomas: A Single Center Experience with 33 Cases

Ermal Likaj*, Selman Dumani, Saimir Kuci and Ali Refatllari

Cardiac Surgery Department, University Hospital Center Mother Theresa, Albania

*Corresponding author: Ermal Likaj, Cardiac Surgery Clinic, Rruga e Dibres, Albaniat

Received: September 02, 2020; Accepted: September 24, 2020; Published: October 01, 2020

Abstract

Objectives: In this single-center study we reviewed our experience with a significant number of cardiac myxomas operated in the period January 2004 to January 2016.

Patients and Methods: There were 33 consecutive patients operated for cardiac myxoma. We had a female dominance in the population with 23 (69.7%) females and 11 (30.3%) males. Mean age at operation was 55±12.33 years. A detailed clinical and echocardiographic early and long-term examination of these patients was done during this period.

Results: Most myxomas originated from the left atrium in 31 (94%) patients, and the remainder from the right atrium in 2 (6%) patients. On echocardiography, the myxomas produced a prolapse into the left ventricle in 42.4% of the patients and mitral stenosis in 30.3%. Cardiac signs like dyspnea (57.57%) and syncope (27.27%) appeared in the majority of the patients and led to the diagnosis. Preoperative embolic events had occurred in 12.12%. Coronary angiography was done in 27 patients and two of them had isolated coronary stenosis.

Median sternotomy and cardiopulmonary bypass with separate bicaval cannulation was the routine approach. Bilateral atriotomy or transseptal incisions were the preferred approaches that were used. The atrial septum at the site of insertion was resected in 25 (75.75%) of the patients and it was closed with a pericardial patch in 12 (36.36%) patients. Mean cross-clamp time was 39.6±14.7 min. Three patients received a concomitant surgical procedure: bypass grafting (2 patients) and mitral valve replacement (1 patient).

The early mortality rate was 3.0% (one 80 years old patient died of massive gastrointestinal bleeding). Early complications included atrial fibrillation (3 patients), pericardial effusion (2 patients), revision for bleeding (2 patients) and stroke (1 patient). Postoperatively, 85.23% of the patients remained without cardiac symptoms. Long term follow up was 63.48±43.55 months and the prognosis was excellent. No patient is re-operated up to date for recurring myxoma.

Conclusion: Myxomas were usually detected and operated on in symptomatic patients. A high index of suspicion seems important for early diagnosis. Echocardiography was the key imaging examination for the diagnosis. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death.

Keywords: Myxoma; Embolization; Tumor

Introduction

Intracardiac myxoma is the most common tumor of the heart with an estimated incidence of 0.5 per million population per year [1]. In cardiac surgery, regarding the operations with cardio-pulmonary bypass, 0.3% are resections of a cardiac myxoma [2]. Up to 80% of myxomas are localized in the left atrium, of which 75% involve the interatrial septum; 7-20% are found in the right atrium; the rest of up to 10% each are either biatrial, in the right ventricle, or in the left ventricle [2-4]. The symptoms related to the presence of the tumor inside the heart depend on the size and the localization of this tumor. In this single-center study we reviewed our experience with a significant number of cardiac myxomas operated in the period January 2004 to January 2016. A detailed clinical and echocardiographic early and long-term examination of these patients was done during this period.

Patients and Methods

There were 33 consecutive patients operated for cardiac myxoma. We had a female dominance in the population with 23 (69.7%) females and 11 (30.3%) males. Mean age at operation was 55±12.33 years.

Results

Echocardiography

Echocardiography was the gold standard for the detection and the description of the tumor. Most myxomas originated from the left atrium in 31 (94%) patients, and the remainder from the right atrium in 2 (6%) patients. On echocardiography, the myxomas produced a prolapse into the left ventricle in 42.4% of the patients and mitral stenosis in 30.3%. Detailed data obtained on echocardiography are presented in the following Table 1.