Abstract
Cardiac myxoma is the most commonly diagnosed cardiac tumour. Infection of herpes simplex virus 1 (HSV1) has been postulated to be a factor for this pathologic entity. The aim of the current study was to evaluate the association between HSV 1 and myxoma occurrence. Between 1965 and 2005, 70 patients (36 female, mean age: 52.6 years) underwent a resection of myxoma. Selected variables such as hospital mortality and morbidity were studied. A follow-up (FU; mean FU time: 138 ± 83 months) was obtained (76% complete). Immunohistological studies with monoclonal antibodies against HSV type 1 were performed on tumour biopsies of 40 patients. The mean age was 53 ± 16 years (range 23 to 84 years, 51% female). Of the investigated population, 31 (44%) were in New York Heart Association (NYHA) class III-IV. Mitral valve stenosis was identified in 14 patients (20%), and in 25 (36%) patients mitral valve was insufficient. During hospitalisation 3 patients suffered from a transient neurological disorder, and in addition to myxoma resection 18 (25.7%) patients had to undergo an additional intervention. The overall survival rate was 91% at 40 years. There was no early postoperative mortality in follow-up, although 4 patients died and 2 patients had been re-operated on for recurrent myxomas after 2 and 9 years. Immunohistology revealed no positive signals for HSV-1 antigens among the 40 analysed cases. Complete surgical resection, septum included, was the treatment of choice and mandatory to prevent relapse. Peri-operative morbidity and mortality over 40 years remained low, and no association between HSV infection and occurrence of cardiac myxoma was found.
Highlights
Primary tumour of the heart is a rare entity with incidence ranging between 0.00071 and 0.0029% of unselected patient autopsies [1]
Mitral valve stenosis was identified in 14 patients (20%), and in 25 (36%) patients mitral valve was insufficient
Immunohistology revealed no positive signals for HSV-1 antigens among the 40 analysed cases
Summary
Primary tumour of the heart is a rare entity with incidence ranging between 0.00071 and 0.0029% of unselected patient autopsies [1]. 80% of the tumours are benign and nearly half of these are myxomes [2]. It seems that intracardiac myxoma is a frequent pathology which may be found in the left atrium in 80% of cases, 7 to 20% are found in the right atrium, and the remaining 10% are diagnosed either in the left or right ventricle [3]. As well the ante mortem diagnosis, of this pathological entity seems to be very successful, the underlying cause remains unclear. It is true that inflammatory symptoms are present in about half of the patients with a diagnosis of myxoma, including fatigue, fever, weight loss and laboratory abnormalities (elevation of leukocyte count, IL6, erythrocyte sedimentation rate, and serum C-reactive protein). Our experience from over 40 years of follow-ups, including treatment modalities and long-term results, in 70 cardiac myxoma patients are reported
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