Clinicopathological Correlation of Cardiac Myxoma- Insights from a Large Volume Tertiary Cardiac Center in South India

Abstract

Background: Cardiac myxomas are the most common benign primary cardiac tumors. They present with a variety of nonspecific cardiac and noncardiac symptoms. Six decades into the first description of the tumor, the explanation of noncardiac symptoms remains an enigma. Literature is sparse to look into the histopathological correlation of the symptoms. Materials and Methods: A prospective study of 47 myxoma patients operated on in our center between August 2016 and December 2018 wherein, their demographic data, electrocardiogram (ECG), echocardiography data, hematological and radiological parameters, and histopathological features were analyzed. Results: Among 47 myxoma patients, 27 were female and 20 were male patients, with an average age of presentation being 48.55 ± 14.01 years for females and 43.81 ± 12.98 for males, P = 0.006. Dyspnea was the most common presenting symptom, seen in 37 (78.4%) patients. Tumor plop was more common among patients with embolization. Ninety-four percent of the myxomas were mobile and solitary, causing significant mitral valve obstruction in 69% of cases and mitral valve regurgitation in 79% of patients. Pulmonary artery hypertension because of myxomas was found in 38% of the patients. The left atrial enlargement was the most common ECG abnormality and was found in 13 (27.7%) patients. Elevated serum C-reactive protein was associated with palpitation whereas neutrophilic infiltration of the tumor was associated with chest pain. Three of the patients recruited were recurrent cases. Infective endocarditis was seen in one patient. Conclusion: Echocardiography gives significant information about the tumors, including the site, mobility, morphology, numbers, and the correlation of symptoms which are due to hemodynamic disturbances caused by the tumor. All the myxomas in our study were solitary in nature and most of them were attached to left interatrial septum at the level of fossa ovalis.