Long-term follow-up of 82 patients after surgical excision of atrial myxomas

A Rare Case of Both Cardiac Myxoma and Left Coronary AVF, Diagnosis, and Management

We present the case of a 62-year-old woman who was diagnosed with both cardiac myxoma and left coronary AVF, and we go on to discuss the course of her treatment and the outcome. In conclusion, this case study highlights the rare coexistence of an atrial myxoma and a congenital coronary arteriovenous fistula in a 65-year-old woman. A thorough cardiovascular evaluation using echocardiography and advanced imaging facilitated accurate diagnosis and informed surgical planning. The surgical approach featured the simultaneous resection of the myxoma and direct repair of the fistula, effectively minimizing surgical risks. A 65-year-old female presented with complaints of chest pain and shortness of breath that were exacerbated by physical activity. The results of angiography confirmed that the mass in the left atrium was indeed an atrial myxoma. Additionally, the angiography revealed a congenital arteriovenous fistula (AVF) between the left coronary arteries and the left atrium, adding another layer of complexity to the patient's condition.

Ticking Time Bomb: Embolic Risks and Complex Management of an Exceptionally Large Papillary Fibroelastoma

•PFEs carry significantly increased risk of embolic stroke. •This case demonstrates that PFEs may grow very large and cause hemodynamic significance. •Multidisciplinary surgical evaluation is crucial in reducing morbidity and mortality of PFEs.

Cardiac myxomas: causes, presentations, diagnosis, and management

Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.

Epidemiology of Cardiac Myxoma in the Kingdom of Bahrain

BACKGROUND

Cardiac myxomas (CM) are the most prevalent type of primary cardiac tumour. The majority of primary cardiac tumours, including CM, are found to be benign. In the context of this study, the objective was to investigate and analyse the experience of CM over a period of 10 years, specifically in Bahrain. By examining this particular subset of cardiac tumours, valuable insights can be gained regarding their prevalence, clinical presentation, diagnostic methods, treatment approaches, and outcomes in the Bahraini population.

METHODS

We retrospectively evaluated the medical records of 20 patients who presented with CM at the Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre in the Kingdom of Bahrain from January 2010 to January 2021. All patients had transthoracic echocardiography to establish a preoperative diagnosis. All of the patients underwent an operation using the median sternotomy, and a histopathology examination confirmed the final diagnosis.

RESULTS

The mean age at the time of presentation was 57 (± 18.1) years, ranging from 17 to 80 years, and 55% (12 patients) were female. Dyspnea (n=8, 40%) and peripheral embolism (n=4, 20%), which include cerebrovascular accidents and acute monocular vision loss, were the most frequently observed symptoms. The largest diameter of the myxoma was 5.1 cm (±1.7). The left atrium was the predominant location for myxoma formation (n=16, 80%), with the majority of the myxomas attached to the atrial septum.

CONCLUSION

CM poses a significant risk of cardiac and systemic complications. Early detection and timely gross-complete resection result in excellent early and long-term outcomes.

Diagnosis and Treatment of Cardiac Myxoma

Cardiac myxoma is the most common primary cardiac neoplasm. It is a benign tumor that typically arises in the left atrium, specifically from the interatrial septum adjacent to the fossa ovalis. We present a case of a 71-year-old male presenting with hematuria that was incidentally found to have a left atrial myxoma on a CT urogram. Follow-up CT and MRI of the heart demonstrated findings compatible with myxoma. Cardiothoracic surgery was consulted, and the patient underwent resection of the left atrial mass, which was confirmed to be a myxoma on pathology.

Left Atrial Myxoma With Aortic Insufficiency Leading to Cerebrovascular Accident

Primary cardiac tumors are extremely rare and can lead to significant neurologic symptoms if not diagnosed and treated appropriately. Cardiac myxomas represent the most common subtype of cardiac tumors and are typically located on the left side of the heart and, when diagnosed appropriately with echocardiography, are typically treated with surgical excision. Simultaneous presentation of myxoma and valvular insufficiency is rare and under-documented. This is a rare case of a patient with a left atrial myxoma and aortic insufficiency leading to cerebrovascular symptoms.

Rare Presentation of Postpericardiotomy Syndrome After Left Atrial Myxoma Removal

Postpericardiotomy syndrome (PPS) is a known complication of cardiac valve surgery, but it has not been commonly reported as a postoperative complication of cardiac myxoma removal. A 78-year-old female with hypertension and atrial fibrillation presenting with angina was found to have a large left atrial myxoma (7.5 cm × 4.4 cm). The myxoma was resected; however, 1-week postoperation hemoglobin and blood pressure decreased with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Limited transthoracic echocardiogram (TTE) showed moderate pericardial effusion, confirming the diagnosis of PPS. This case highlights the importance of monitoring patients postremoval of myxoma for symptoms of PPS.

Cardiac myxomas: A narrative review

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.

Right Anterolateral Thoracotomy Versus Sternotomy for Resection of Benign Atrial Masses: A Systematic Review and Meta-Analysis

OBJECTIVE

Primary benign cardiac tumors are rare disease entity that predominantly originate from the atria. Benign masses can induce heart failure, arrhythmia, or thromboembolic events. Therefore, surgical excision is often indicated. Current guidelines on the preferred approaches for resection (i.e., median sternotomy [MST] or right anterolateral thoracotomy [RAT]) are lacking. The aim of the current meta-analysis was to evaluate all studies comparing RAT to MST for excision of benign atrial masses in terms of safety, efficacy, and complications.

METHODS

The PubMed and EMBASE databases were searched through 9 June 2020. Data regarding mortality, complications, recurrence, ICU stay, and length of hospital stay were extracted and submitted to meta-analysis using random effects modelling. Heterogeneity was assessed by the I ² test.

RESULTS

Four retrospective observational studies were included, including 196 patients (RAT n = 97, MST n = 99). Mortality was 0% in both groups. Recurrence was <1% in the RAT group and 0% in the MST group. Complication rate tended to be lower in favor of the RAT group. Furthermore, RAT was associated with lower length of ICU stay (-17.7 hr, P = 0.01) and hospital stay (-4.0 days, P < 0.001). No significant differences in cardiopulmonary bypass (P = 0.09) and cross-clamp times (P = 0.15) were observed.

CONCLUSIONS

The RAT approach is as safe and effective as MST for the excision of benign atrial masses. Moreover, RAT is associated with a reduced complication rate and a reduced duration of hospitalization and could be considered as the preferred approach in anatomically suitable patients.

Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases

OBJECTIVE

To assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention.

METHODS

Retrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5-15) years.

RESULTS

The cross-clamp time and cardiopulmonary bypass times were 41.1 ± 21.4 and 65.2 ± 27.3 min, respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7% (n = 3). During the follow-up period, tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis, age (HR = 1.05, 95% CI: 1.02-1.09, P < 0.001), left atrial diameter (HR = 1.23, 95% CI: 1.08-1.36, P = 0.012), and mitral valve surgery (HR = 1.17, 95% CI: 1.05-1.29, P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07, 95% CI: 1.04-1.10, P = 0.003) and multiple surgical procedures (HR = 1.18, 95% CI: 1.06-1.29, P = 0.012) were significantly associated with overall mortality.

CONCLUSIONS

Atrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age, left atrial diameter, and mitral valve surgery were independent predictors of outcomes.

Outcomes of surgical treatment in 115 patients with primary cardiac tumours: a 15-year experience at a single institution

Background

Primary cardiac tumours are rare, and few studies have examined large samples. The aim of this study was to review a single institution's 15 years of experience with primary cardiac tumours.

Methods

We conducted a retrospective analysis of 119 consecutive patients admitted to the Nanjing Drum Tower Hospital from April 2002 to January 2017. Five patients declined surgery due to illness or for financial reasons, and one patient underwent a second operation due to tumour recurrence 10 years after the first operation. In total, 115 patients underwent surgery. The surgeons used median sternotomy and a right atrial approach to complete the gross total resection. The patients were separated into three groups according to their tumour pathology (myxomas, other benign tumours, or malignant tumours). A total of 84 patients were followed up for an average of 34.8±31.2 months (range 2-141 months).

Results

The sites of the cardiac tumours included the left atrium (n=93, 80.1%), right atrium (n=14, 14.0%), left ventricle (n=2, 1.7%), valves (n=7, 6.0%), and other sites (n=1, 0.8%). According to the postoperative pathology, 99 (86.0%) tumours were classified as myxomas, 8 (7.0%) were other types of benign tumours, and 8 (7.0%) were malignant tumours. Patients with malignant tumours had a longer surgical time (P=0.035) and postoperative hospitalization time (P=0.009). Patients with myxoma tumours exhibited better 5-year survival than patients with malignant tumours (95.7% vs. 57.1%, P<0.001).

Conclusions

In the Chinese population, the incidence of primary cardiac tumours is mainly attributable to myxomas. Gross total resection is a safe and effective treatment for both benign and malignant tumours. Long-term survival is satisfactory for benign tumours but low for malignant tumours, and a risk of recurrence exists. Postoperative chemotherapy or radiotherapy may be needed to achieve better outcomes.

Risk prediction for emboli and recurrence of primary cardiac myxomas after resection

BACKGROUND

Risk factors for embolism and recurrence of primary cardiac myxoma are not well established. This study aimed to assess the risk factors for embolism and recurrence of cardiac myxoma, as well as the survival of the patients.

METHODS

The medical records of 207 consecutive patients treated for primary cardiac myxoma between September 1988 and October 2014 were retrospectively analyzed. All diagnoses were pathologically confirmed. Data were collected to identify the risk factors influencing the prognosis.

RESULTS

Mean age at surgery was 44.2 ± 15.8 years. Operative mortality (within 30 days of the surgery) occurred in seven patients. Mean follow-up was 9.35 ± 6.55 years. Embolism occurred in 32 (15.5 %) patients before surgery. Multivariate analysis indicated that small (≤ 4.5 cm) myxoma (OR = 5.14; 95 % CI, 2.30-11.94; P < 0.0001) and soft, gelatinous myxoma (OR = 5.84; 95 % CI, 1.91-25.61; P = 0.001) were independently associated with the occurrence of embolism. Ten patients experienced recurrences. After excluding the patients who died within 30 days of surgery, survival was 92.7 % at 10 years. Age, sex, tumor size, cardiopulmonary bypass duration, aortic cross clamp duration, tumor appearance, and pre-operative embolism were not associated with early mortality. Multivariate analysis showed that multicentric myxomas were independently associated with recurrence (OR = 9.45, 95 % CI, 2.15-41.3, P = 0.004).

CONCLUSIONS

The surgical resection of primary cardiac myxoma is associated with excellent long-term survival. Tumors ≤ 4.5 cm and soft tumors were independent risk factors for embolism. Multicentric cardiac myxoma was an independent risk factors for recurrence of myxoma.