A REVIEW OF THE LITERATURE ON CARDIAC MYXOMAS AND PRESENTATION OF TWO ELDERLY SURGICAL CASES

Abstract

Two cases of cardiac myxoma are presented. Both underwent successful surgical excision at age 75. Since the first report of successful surgical treatment in 1960, 379 operative cases have been collected in Japan. Two hundred nineteen cases (57.8%) were female and one hundred sixty cases (42.2%) were male. The patients' ages ranged between 2 months and 78 years, with a mean age of 44.3±16.1 years. The tumor was located most commonly in the left atrium (329 cases, 86.8%). Also reported were 32 (8.5%) right atrial tumors, 13 (3.4%) right ventricular tumors and 5 (1.3%) left ventricular tumors. Right atrial myxomas exceeded left atrial myxomas in both weight and size (right atrium 126.3±67.8g, left atrium 57.8±38.5g p<0.001; right atrium 7.8±2.5cm, left atrium 6.6±1.6cm p<0.05). The presurgical complication of embolism occurred in 60 cases (45 cases of cerbral embolism, 19 cases of lower thigh embolism). Operative goals included prevention of recurrence, minimization of intraoperative embolism or implantation, and exploration of all four cardiac chambers. Operative approaches included transseptal incision via the right atrial incision (34 cases, 35.4%), biatrial incision (22 cases, 22.9%) and Dubost's incision (19 cases, 19.8%). Tumor extirpation was combined with atrial septum or atrial wall excision in 79 cases (69.9%) and with atrial en-docardial excision in 17 cases (15.0%). Simple resection of the myxoma was performed in 17 cases (15.0%). The five reported cases of recurrence were all left atrial in location. On case of right-sided implantation was also reported. The mean age of the recurrent cases, 26.6±5.22 years on the initial operation, was significantly lower than that of all left atrial myxomas, 45.8±15.7 years (p<0.01). Eradication of recurrence proves difficult, but this study suggests that the most successful surgical approach includes concomitant excision of myxoma and atrial septum or wall as well as close follow-up with echocardiography, especially in young patients.