A 30-Year-Single-Center Experience in Atrial Myxomas: From Presentation to Treatment and Prognosis

Abstract

Background The symptoms of myxoma are atypical, vary greatly, and may mimic numerous conditions. Our aim was to investigate the correlation of localization, size, and consistency of myxoma with its treatment and prognosis.

Methods Over a span of 30 years, 74 consecutive patients (24 men, mean age 46.7 years) were surgically treated for echocardiography-diagnosed myxomas at our center.

Results Left atrial myxomas were more frequent (89.19%), with the racemous form being predominantly left-sided and having no difference in tumor size regardless of localization. Three patients were asymptomatic; and those who were symptomatic, symptoms appeared 2 to 36 months (mean 13.60 ± 7.52) before diagnosis. Nonspecific symptoms and signs were present in 91.98% of patients, whereas specific symptoms and signs were present in 74.32%. More often, patients with myxomas >5 cm in diameter were symptomatic. Embolic events occurred in 15 patients (9 cerebral, 4 pulmonary, 2 peripheral), more frequently in right atrial myxomas of >5 cm diameter. All patients were surgically treated on diagnoses, with no intraoperative mortality or recurrences.

Conclusions Symptoms in our cardiac myxoma patients were more pronounced when the myxomas were left-sided, racemous, and over 5 cm in diameter. Even in asymptomatic patients, a high index of suspicion assured timely diagnosis and management.

Keywords

atrial myxomas - preoperative symptoms - influence

• References

• 1 Burke A, Virmani R. Tumors of the heart and the great vessels. In: Rosai J, , ed. Atlas of Tumor Pathology. Third series, Fascicle 16. Washington, DC: Armed Forces Institute of Pathology; 1996: 231
• 2 Thiene G, Valente M, Lombardi M, Basso C. Tumors of the heart. In: Camm AJ, Lüscher TF, Serruys PW, , eds. The ESC Textbook of Cardiovascular Medicine. 2nd ed. USA: Oxford University Press Oxford, New York; 2009: Chapter 20
• 3 Mikić A, Obrenović-Kirćanski B, Kočica M , et al. Miksomi srca – klinička slika I uticaj hirurške tehnike na udaljenu prognozu. Srp Arh Celok Lek (Beograd) 2007; 135 (7–8) 401-406
• 4 Kanjuh V, Lačković V, Seferović P, Ađić Čemerlić N, Oprić D. Myxoma pendulum globosum et racemosum cordis. In: Ostojić M, Kanjuh V, Beleslin B, , eds. Kardiologija. Beograd: Zavod za udžbenike; 2011: 330-332
• 5 Gošev I, Paić F, Durić Ž , et al. Cardiac myxoma the great imitators: Comprehensive histopathological and molecular approach. Int J Cardiol 2012;
• 6 Peters MN, Hall RJ, Cooley DA, Leachman RD, Garcia E. The clinical syndrome of atrial myxoma. JAMA 1974; 230 (5) 695-701
• 7 Meng Q, Lai H, Lima J, Tong W, Qian Y, Lai S. Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases. Int J Cardiol 2002; 84 (1) 69-75
• 8 Schvartzman PR, White RD. Imaging of cardiac and paracardiac masses. J Thorac Imaging 2000; 15 (4) 265-273
• 9 Murphy MC, Sweeney MS, Putnam Jr JB , et al. Surgical treatment of cardiac tumors: a 25-year experience. Ann Thorac Surg 1990; 49 (4) 612-617 , discussion 617–618
• 10 Miralles A, Bracamonte L, Soncul H , et al. Cardiac tumors: clinical experience and surgical results in 74 patients. Ann Thorac Surg 1991; 52 (4) 886-895
• 11 Goldstein MM, Casey M, Carney JA, Basson CT. Molecular genetic diagnosis of the familial myxoma syndrome (Carney complex). Am J Med Genet 1999; 86 (1) 62-65
• 12 Pochis WT, Wingo MW, Cinquegrani MP, Sagar KB. Echocardiographic demonstration of rapid growth of a left atrial myxoma. Am Heart J 1991; 122 (6) 1781-1784
• 13 Karlof E, Salzberg SP, Anyanwu AC, Steinbock B, Filsoufi F. How fast does an atrial myxoma grow?. Ann Thorac Surg 2006; 82 (4) 1510-1512
• 14 Obrenović-Kirćanski B, Bošković D, Simin N , et al. Miksomi srca – klinička slika, tok i udaljena prognoza. Srp Arh Celok Lek (Beograd) 1994; 122 (1–2) 30-32
• 15 Rafajlovski S, Ilić R, Gligić B , et al. [Diagnosis and results of treatment of heart myxoma]. Vojnosanit Pregl 2011; 68 (10) 851-855
• 16 Burke A, Jeudy Jr J, Virmani R. Cardiac tumors: an update: cardiac tumors. Heart 2008; 94 (1) 117-123
• 17 Castells E, Ferran V, Octavio de Toledo MC , et al. Cardiac myxomas: surgical treatment, long-term results and recurrence. J Cardiovasc Surg (Torino) 1993; 34 (1) 49-53
• 18 Keeling IM, Oberwalder P, Anelli-Monti M , et al. Cardiac myxomas: 24 years of experience in 49 patients. Eur J Cardiothorac Surg 2002; 22 (6) 971-977
• 19 Bortolotti U, Maraglino G, Rubino M , et al. Surgical excision of intracardiac myxomas: a 20-year follow-up. Ann Thorac Surg 1990; 49 (3) 449-453
• 20 Ha JW, Kang WC, Chung N , et al. Echocardiographic and morphologic characteristics of left atrial myxoma and their relation to systemic embolism. Am J Cardiol 1999; 83 (11) 1579-1582 , A8
• 21 Endo A, Ohtahara A, Kinugawa T , et al. Characteristics of 161 patients with cardiac tumors diagnosed during 1993 and 1994 in Japan. Am J Cardiol 1997; 79 (12) 1708-1711
• 22 Bjessmo S, Ivert T. Cardiac myxoma: 40 years' experience in 63 patients. Ann Thorac Surg 1997; 63 (3) 697-700