Clinical experience and surgical considerations in the management of cardiac myxomas

Abstract

Objectives: We studied the clinical presentation of cardiac myxomas and the morbidity,mortality and recurrence rate following surgery at our institution over a 9 year period. Patients and Methods: Between January 1995 and October 2003, a total no of 6803 cardiac operations were performed. Of these 61 patients (28 males, 33 females) underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made.Complete tumor excision with a cuff of interatrial septum followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 57 patients who survived the surgery, 53 patients were followed up at regular intervals for recurrence. The mean follow-up period was 56 months. Results: Myxomas constituted 0.89% of the total cardiac operations at our institution.They most commonly occurred in the fourth decade. The commonest location was the Left Atrium (LA) (80%) followed by the Right Atrium (18%). Only one patient had myxoma in the Right Ventricle(RV). Patients with LA myxoma simulated mitral stenosis clinically whereas all patients with RA myxoma presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. 57 patients (i.e. 94%) survived the operation. 2 recurences were noted, one at 3 years and the second 8 years after surgery. No late deaths were observed in this study. Conclusion: Myxomas formed a 0.9% of cardiac operations performed at our institution.This figure is higher than that reported in western literature(0.3%).A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow–up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity.Our data suggests the need for close follow up of all patients for long periods to detect recurrence. (Ind J Thorac Cardiovasc Surg, 2004; 20: 77–82)