Cardiac Myxoma, a Rare But Most Common Encountered Cardiac Tumor: A Single Center Experience

Document Type: Original Article

Authors

Cardiovascular and Thoracic Surgeon, Department of Cardiovascular & Thoracic Surgery, Government medical college & Super speciality Hospital, Nagpur 440009 , Maharashtra, India.

Abstract

Introduction: Cardiac myxoma is a benign and rare tumor, which can present with a grim phenomenon if the presentation is late or the diagnosis and surgery are delayed. The purpose of this study was to share our institutional experience of cardiac myxoma.
Material and Methods: This retrospective study was conducted to evaluate patients undergoing procedures at a single tertiary care centre for the treatment of cardiac myxoma during January, 2007 to December, 2017. Preoperative diagnosis was made by assessing clinical presentation and doing echocardiography. Complete tumor excision was performed, and all the patients were followed up for recurrence and complications.
Results: A total of 45 cases of cardiac myxoma (13 males and 32 females) with the mean age of 37.5 years old (ranged between 16 and 60 years old) were operated over the period of 10 years. Cardiac myxoma constituted about 0.69% of all cardiac cases operated at our institute. Out of all the subjects, 41, 3, and 1 cases had left atrial, right atrial, and right ventricular involvements, respectively. Additionally, 43 patients (95%) survived the surgery, one recurrence was observed during the follow-up period.
Conclusion: Cardiac myxoma is the most common cardiac tumor account for very small percentage of patients with heart disease. Early clinical suspicion and the use of imaging modalities are key to early diagnosis of this condition. Although these tumors have a risk for severe cardiac and systemic symptoms, referral to experienced centers for prompt surgical resection under cardiopulmonary bypass provides excellent early and long-term results.

Keywords


  1.  McAllister H, Fenoglio J: Tumors of the cardiovascular system. In: Hartmannn W, Cowan W (eds.): Atlas of tumor pathology. Washington,DC: Armed Forces Institute of Pathology 1978: 1–20
  2. McAllister HA Jr, Hall RJ, Cooley DA. Tumors of the heart and pericardium. Curr Probl Cardiol. 1999;24:57–116.
  3. Reynen K. Cardiac Myxomas. N Eng J Med. 1995;333:1610-1617.
  4. Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol. 1997;80:671-682.
  5. Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P. Primary cardiac tumors: experience with 25 cases. J Thorac Cardiovasc Surg. 1982;83:339 –348.
  6. DePace NL, Soulen RL, Kotler MN, Mintz GS. Two dimensional echocardiographic detection of intraatrial masses. Am J Cardiol. 1981;48:954–60.
  7. Chitwood Jr Wr. Cardiac neoplasms: current diagnosis, pathology and therapy. J Cardiovasc Surg. 1988;3:119e154.
  8. MacGowan SW, Sidhy P, Aherne T, Luke D, Wood AE, Neligan MC. Atrial myxoma: national incidence, diagnosis and surgical management. Isr J Med Sci. 1993;162:223e22
  9. Castells E, Ferran V, Octavio de Toledo MC, Calbet JM, Benito M. Cardiac myxomas: surgical management, long term results and recurrence. J Cardiovasc Surg (Torino). 1993;34:49e53.
  10. Keeling IM, Oberwalder P, Anneli-Monti M, Schuchlenz H. Cardiac myxomas: 24 years of experience in 49 patients. Eur J Cardiothorac Surg. 2002;22:971e977.
  11. David R. Jones, Herbert E. Warden, Gordon F. Murray, Ronald C. Hill, Geoffrey M. Graeber, Jose L. Cruzzavala, et al. Biatrial approach to cardiac myxomas: A 30 year clinical experience. Ann Thorac Surg. 1995;59:851-6.
  12. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patane F, LaTorre M, et al. Primary cardiac tumors: Early and late results of surgical treatment in 91 patients. Ann Thorac Surg 1999, 68: 1236-41.
  13. Peachell JL, Mullen JC, Bently MJ. Biatrial Myxoma: A Rare Cardiac Tumor. Ann Thorac Surg. 1998;67:1768-9.
  14. Padhy K, Krishnagopal K, Sabanayagam N, Pereira IP, Nachiappan M. Atrial Myxoma: 8 year JIPMER Experience. IJTCVS. 2001;17:230-2.
  15. Bortolotti V, Maraglino G, Rubino M, Santini F, Mazzucco A, Milano A, et al; Surgical excision of intracardiac myxoma: A 20 year follow up. Ann Thorac Surg. 1990;49:449-53.
  16. Goodwin JF. Spectrum of cardiac tumors. Am J cardio. 1968;21:307.
  17. Fyke FE, Seqard JB, Edwards WD, Miller FA, Reeder GS, Schattenberg TT, et al. Primary cardiac tumors: experience with 30 consecutive patients since introduction of two dimensional echocardiography. J Am Coll Cardiol. 1985;5:1465.
  18.  Tipton BK, Robertson JT, Robertson JH. Embolism to the central nervous system from cardiac myxoma: report of two cases. J Neurosurg. 1977;47:937.
  19. Mundinger A, Gruber HP, Dinkel E. Immaging cardiac mass lesions. Radiol Med. 1992;10:135-40.
  20. Pechacek LW, Gnzalez-Camid F, Hall RJ, Garcia E. The echocardiographic spectrum of myxoma: a ten year experience. Tex Heart Inst J. 1986;13(2):179-95.
  21. Obeid AI, Marvasti M, Parker F, Rosenberg J. Comparison oftransthoracic and transesophageal echocardiography in diagnosis of left atrial myxomas. Am J Cardiol. 1989;63:1006–8
  22. Tighe DA, Rousou JA, Kenia S, Kulshrestha P. Transesophageal echocardiography in the management of mitral valve myxoma. Am Heart J. 1995;130:627-9.
  23. Ahraaz Wyne, Medicine 2010, Reviewed by Dr. David Massel. A Look at Cardiac Myxoma, UWOMJ 77(2) 2008
  24. Symbas PN, Hatcher CR, Gravanis MB. Myxoma of the heart: Clinical and experimental observations. Ann Surg. 1976;183:470.
  25. Dato GMA, Benidictis M, Dato AA, Ricci A, Sommariva L, Depaulis R. Long term follow up of cardiac myxoma, (7-31years). Journal of Cardiovascular Surgery. 1993;34(2):114-43.
  26. Khan MS, Sanki PK, Hossain MZ, Charles A, Bhattacharya S, Sarkar UN. Cardiac myxoma: A surgical experience of 38 patients over 9 years, at SSKM hospital Kolkata, India. South Asian J Cancer 2013;2:83-6
  27. Mishra, Amit et al. Operative management of intracardiac myxomas: A single center experience Medical Journal Armed Forces India , Volume 70 , Issue 1 , 5 – 9
  28. Jones DR, Warden HE, Murray GF, Hill RC, Graeber GM, Cruzzavala JL, et al. Biatrial approach to cardiac myxomas: A 30-year clinical experience. Ann Thorac Surg. 1995;59:851–6.
  29. Meynes B, Vanclemmput J, Flameng W, Daenen W. Surgery for cardiac myxoma: A 20-year experience with long term follow-up. Eur J Cardiothorac Surg. 1993;7:437–40.
  30. Bhan, A, Mehrotra, R, Choudhary, K, et al. Surgical experience with intracardiac myxomas: Long-term follow-up. Ann Thorac Surg. 1998;66:810.
  31. Bakaeen FG, Reardon MJ, Coselli JS, Miller CC, Howell JF, Lawrie GM, Espada R, Ramchandani MK, Noon GP, Weilbaecher DG, DeBakey ME. Surgical outcome in 85 patients with primary cardiac tumors. The American Journal of Surgery. 2003 Dec 1;186(6):641-7.
  32. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patane F, La Torre M, Barbato L, Verzini A, Fortunato G, di Summa M. Primary cardiac tumors: early and late results of surgical treatment in 91 patients. The Annals of thoracic surgery. 1999 Oct 1;68(4):1236-41..
  33. Kabbani SS, Jokhadar M, Meada R, Jamil H, Abdun F, Sandouk A, Nabhani F. Atrial myxoma: report of 24 operations using the biatrial approach. The Annals of thoracic surgery. 1994 Aug 1;58(2):483-7.
  34. Farah MG. Familial cardiac myxomas: a study of relatives of patients with myxoma. Chest. 1994;105:65e68.
  35. Van Gelder HM, O’Brien DJ, Staples ED, Alexander JA. Familial cardiac myxoma. Ann Thorac Surg. 1992;53:419e424