P1765 Cardiac myxomas: echocardiographic findings and clinical correlation, a 15-years single-center experience

Abstract

Abstract Background Cardiac myxomas, the most frequent primary benign cardiac tumours, are in some cases lethal due to impaired cardiac dynamics and thromboembolic potential. When tumors are diagnosed and surgically resected in a timely manner, they lose their deleterious potential and patients are cured, except for rare cases of recurrence. Purpose We sought to describe the association of clinical presentation, course and echocardiographic findings, dividing myxomas on the basis of location, morphology, size, mobility, echocardiographic appearance. Methods We reviewed the medical records and retrospectively analyzed the transthoracic echocardiograms of 51 patients (31female, aged 63 ± 14), who underwent cardiac surgery and were diagnosed at histology with myxoma, between 2004 and 2019. Myxomas were classified according to their location (typical when attached to the interatrial septum in the left side, or atypical), diameters, shape (solid and round shape, or irregular and multilobulated), echocardiographic appearance (homogeneous or heterogeneous), mobility (high mobile pedunculated, or nonmobile), obstruction (no or impaired mitral/ tricuspid dynamics). Depending on symptoms patients were referred to emergency or elective surgery. Results In 28 patients (55%) myxomas were incidental echocardiographic findings (Figure 1 A), 23 patients (45%) reported symptoms at presentation (dyspnea in 15 cases, embolic symptoms in 5 cases, syncope in 3 cases) (Figure1 B). A total of 41 myxomas (80%) were tipically located on the interatrial septum in the left side, followed by the left atrium (5 patients,10%), the right atrium (4 patients, 8%) and the tricuspid valve (1 patient). Symptoms were associated with large size (41 ± 15 mm vs 29 ± 15 mm, p = 0.004 ), high mobility (76% vs 24%, p< 0.001, ), obstruction (75% vs 25%, p = 0.004), heterogeneous aspect (75% vs 25%, p = 0.006) and were not related to location and shape. A maximum diameter > 39 mm distinguished patients with or without symptoms. In patients with symptoms surgery was based only on echo. In the other cases cardiac CT (20 cases) or MRI (8 cases) was performed. All patients received a complete surgical resection, recurrency was observed in one case. Conclusions Clinical presentation relates to the ultrasound characteristics of myxomas: small, non mobile, homogeneous lesions probably benefit of elective surgery. Large size, high mobility, heterogeneous aspect and impaired valves dynamics correlate with symptoms at presentation and emergency surgery is mandatory. Abstract P1765 Figure 1