Unusual location of an atrial myxoma complicated by a secundum atrial septal defect

Intracardiac Masses

Between 1991 and 1998, 8 patients (mean age, 29.6 years) underwent surgery for an intracardiac mass. There were 2 hydatid cysts, 1 angiosarcoma, and 5 myxomas. One patient with myxoma underwent a Syme's amputation due to lower extremity ischemia caused by embolization. The patient with angiosarcoma died of cardiopulmonary failure on the 9th postoperative day. The surviving patients experienced no mortality, complications, or recurrence during follow-up of 0.5 to 5 years.

Myxomas Causing Coronary Emboli Resulting in Acute Myocardial Infarction

A 26-year-old female presented with chest pain, numbness in the legs, and electrocardiographic signs of left ventricular aneurysm and recent myocardial infarction. Transesophageal echocardiography detected a mass in each atria. Angiography demonstrated normal coronary arteries, a left ventricular aneurysm, and an apical thrombus. At surgery, myxomas were excised from both atria and the aneurysm was plicated, followed by peripheral embolectomy. The patient made a good recovery.

Surgical treatment for heart myxomas

According to unselected autopsy data, primary cardiac tumours are a rare entity. About 80% of the tumours are benign and nearly half of these are myxomas. In clinical practice, when diagnosis of this pathological entity is ascertained, decision for surgical treatment is made in order to prevent thromboembolism and obstruction of the valvular apparatus. Surgical resection including total tumour removal is accompanied by low perioperative mortality. The recidive rate is low in sporadic cases. However, in familial syndrome groups, such as the Swiss-Carney syndrome, the recurrence rate is higher.

Cardiac masses, part 2: key imaging features for diagnosis and surgical planning

OBJECTIVE

The objectives of this article are to discuss key radiologic features that differentiate primary and secondary cardiac masses. Clinical scenarios are included to highlight stepwise radiologic workup of tumors of the pericardium, epicardium, myocardium, valves, and chambers. The involvement of key cardiac anatomic structures will also be emphasized to determine resectability and guide surgical planning.

CONCLUSION

Multimodality imaging plays a pivotal role in diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis. In addition to radiologic evaluation of the mass itself, involvement of valvular apparatus, extent of myocardial involvement, or presence of associated coronary artery involvement is necessary to determine resectability and surgical technique.

[Cardiac myxoma complicated with cerebral aneurysms and revealed by an ischemic stroke]

INTRODUCTION

Myxoma is a rare benign primary cardiac tumor. It may cause vascular complications. Neurological symptoms may precede or accompany the diagnosis of myxoma with systemic embolization occurring most often in the cerebral circulation.

OBSERVATION

We report a case of cardiac myxoma complicated with cerebral aneurysms and revealed by an ischemic stroke in a 21-year-old patient. The cardiac myxoma was discovered during the transthoracic echocardiography performed as part of the etiological work-up. Because of the high risk of embolism, the mass was resected and mitral valve surgically repaired. The postoperative outcome was uneventful.

CONCLUSION

Although myxoma is a benign tumor histologically, it can lead to serious complications such as systemic embolism and sudden death.

[Cardiac myxomas (a series of 23 cases)]

OBJECTIVE

This study aims to report clinical particularities, treatment concepts, potential evolution related to cardiac myxoma to the light of our initial experience and reviewed of the literature.

METHODS AND RESULTS

Between May 1980 and January 2005: 23 patients were operated in our service for cardiac myxoma. There were 21 left-atrium myxomas and two in right atrium. The mean age was 42.73 years (range 21 to 60 years). The sex-ratio was 2.28 (16 women and seven men). In four cases, the myxomas were chance findings at echocardiography but the 19 symptomatic patients had different symptoms: dyspnea, palpitations, left ventricular failure, positional syncope, systemic embolism, chest pain or right ventricular failure. The diagnostic of myxoma was realized in all cases by echocardiography. The resection of the tumor and a wide part of the inter-atrial septum were performed in all case. The post-operative course was usually uncomplicated: only one patient had double recurrence and died of mediastinitis after the third operation.

CONCLUSION

The myxoma is considered to be rare, and remains classical emergency with low operative risk, however the risk of recurrence imposes a long-term follow-up by echocardiography.

Right Atrial Trans-Septal Approach for Left Atrial Myxomas—Nine-Year Experience

OBJECTIVE

In this single-center study we reviewed our experience with left atrial myxomas occurring over the past 9 years.

METHODS

Sixty-three patients underwent excision of cardiac myxomas between 1995 and 2004. Of these, 56 patients (32 females and 24 males) had left atrial (LA) myxoma. The mean age was 37.80+12.97 years (range 3.5-67 years). Echocardiography was the only diagnostic evaluation done. The preferred approach for resection was right atrial trans-septal. Annual echocardiographic evaluation was undertaken following surgery. Follow-up is current and available in all the survivors (range 4 months-9 years).

RESULTS

Clinically 75% of the LA myxomas simulated mitral stenosis. The symptoms were present for 2-6 months before operation. Most (86%) LA myxomas were attached to the fossa ovalis. Few (14%) originated from the LA wall, mitral valve annulus and anterior mitral leaflet. One patient succumbed to low cardiac output and another died of massive embolic stroke following surgery. There were no late deaths. Two patients (3.7%) developed left hemiparesis after operation but recovered completely. There was one (1.9%) recurrence 3 years after surgery. Atrial fibrillation occurred in one patient. Mitral insufficiency which was seen in two (3.7%) patients prior to surgery subsided following excision of the tumor. Postoperatively 94% patients remained without symptoms.

CONCLUSION

Owing to the risk of valvular obstruction or embolization early surgery is indicated. Right atrial trans-septal approach is safe and easy. Most patients are asymptomatic following surgery. A yearly follow-up is essential.

A case of left atrial myxoma associated with atrial septal defect

Cardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-old woman referred to the emergency department with loss of consciousness and finally diagnosed as a pedinculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septal defect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture. The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagnosis when patients present with neurological consequences of systemic embolization.