Abstract
ObjectiveWe aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery.MethodsWe retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections.ResultsForty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up.ConclusionAlthough myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.
Highlights
Primary cardiac tumors are rare neoplasms with an autopsy incidence between 0.001% and 0.3%[1,2,3]
Especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor
Myxomas are histologically benign, this type of tumor carries the risk of systemic embolization with subsequent cerebral or peripheral infarctions, intracardiac obstructions, syncope, and sudden death[11,12]
Summary
Primary cardiac tumors are rare neoplasms with an autopsy incidence between 0.001% and 0.3%[1,2,3]. 75-80% of primary cardiac tumors are benign, and of those, more than half are myxomas[1,2,3,4,5,6]. Myxomas are predominantly present in females and, in the majority of patients, they originate from the region of fossa ovalis of interatrial septum in the left atrium[7,8,9,10]. Myxomas are histologically benign, this type of tumor carries the risk of systemic embolization with subsequent cerebral or peripheral infarctions, intracardiac obstructions, syncope, and sudden death[11,12]. Surgical treatment for cardiac myxomas should be performed as soon as possible after diagnosis. The basic principles of surgical treatment for cardiac myxomas include complete wide excision of tumor and avoidance of residual tumor. The most appropriate surgical approach especifically for left atrial myxomas is controversial
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