Predictors of Normalization of Circulating Interleukin-6 after Cardiac Myxoma Resection

Right Ventricular Myxoma Involving the Chordae Tendineae: A Case Report and Literature Review

This case report describes a rare instance of massive right ventricular myxoma (RVM). A 36-year-old woman initially presented with progressive breathlessness and chest heaviness. Imaging revealed a large mass in the mediastinum, which was initially thought to be a pericardial cyst, and it was unclear whether the mass was intracardiac or extracardiac. Extensive investigations and multiple discussions concluded that the mass was a right ventricular mass. Intraoperatively, the mass was confirmed to be in the right ventricle (RV), with involvement of the chordae tendineae and an extremely thinned-out right ventricular free wall. Surgical excision of the tumour from the RV, tricuspid valve repair, and plication of the free wall were performed, leading to significant symptomatic relief. The mass was identified as a myxoma through histological diagnosis. This case highlights the diagnostic challenges and management strategies for RVM.

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.

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.

Autopsy of 54 cases of surgically excised cardiac myxomas. Investigation of their impact on immune response

Introduction

The impact of cardiac myxomas on the immune response is still indefinite, although laboratory tests and histological findings suggest that there is a correlation between myxomas and inflammatory reaction.

Objectives

Our study speculates that cardiac myxomas are associated with inflammatory response and investigates potential elements of inflammation in the histopathological examination and biomarkers from laboratory tests.

Methods

It is a retrospective study and data were collected from a single center between May 2010 to May 2018. Autopsies and laboratory tests of 54 cases were analyzed.

Results

In 20,4% of the autopsies, inflammatory elements were identified. The neutrophil/lymphocyte ratio (NLR) preoperatively is elevated in patients suffering from cardiac myxoma while its value is correlated to the tumor size.

Conclusions

Cardiac myxoma is an entity that affects the immune response of patients. The biomarker NLR could be utilized as a prognostic factor regarding enlarged cardiac myxomas. Future studies still need to be conducted in order to confirm the usefulness of this biomarker on cardiac myxomas.