Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases

Objective To assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention. Methods Retrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5?15) years. Results The cross-clamp time and cardiopulmonary bypass times were 41.1 ± 21.4 and 65.2 ± 27.3 min,respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7%(n = 3). During the follow-up period,tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis,age (HR = 1.05,95% CI: 1.02–1.09,P < 0.001),left atrial diameter (HR = 1.23,95% CI: 1.08–1.36,P = 0.012),and mitral valve surgery (HR = 1.17,95% CI: 1.05–1.29,P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07,95% CI: 1.04–1.10,P = 0.003) and multiple surgical procedures (HR = 1.18,95% CI: 1.06–1.29,P = 0.012) were significantly associated with overall mortality. Conclusions Atrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age,left atrial diameter,and mitral valve surgery were independent predictors of outcomes.

A case of mimicking left atrial myxoma demanding emergency surgery

尽管有在转移的可观的死亡和病态，心脏的集体、临死前的诊断是不平常的。这里，我们 echocardiographically 报导一个左 atrial 团的一个案例 mimicking 粘液瘤，在有肺癌的一个病人。团病理地被证实是变形的癌，它经由左优异肺的静脉的直接侵略进入了左中庭，说明为散布进心和获得在如此的情况中的织物诊断的重要性的肿瘤的不平常的线路的潜力。

Diffuse large B-cell lymphoma of cerebellum five months after left atrial myxoma resection in an old woman

We describe a 70-year-old female patient with diffuse large B-cell lymphoma of the cerebellum;she received resection of a left atrial myxoma five months ago.To the best of our knowledge,to date no association of atrial myxoma with the malignant cerebellar diffuse large B-cell lymphoma has been reported in the literature,except for high level of interleukin-6 (IL-6) in the serum under both conditions.IL-6 as a pro-inflammatory cytokine has been shown to be associated with tumor progression,including inhibition of cancer cell apoptosis and stimulation of angiogenesis.IL-6 concentrations may provide possible aetiological links between atrial myxoma and cerebellar diffuse large B-cell lymphoma in our case.

Atrial Myxoma with a Dual Coronary Artery Supply

Primary cardiac tumours are rare, with myxoma being the most common benign heart tumour. The prevalence of coronary disease or neovascular in patients with atrial myxomas is high, yet angiography is not routinely performed. Echocardiography is preferred for evaluation of myxoma, where coronary angiography clarifies the vascular supply of the tumour and may alter the surgical planning. We here report an interesting and rare case of a left atrial myxoma hyper vascularised by two anomalous arteries, from right coronary artery and circumflex artery demonstrated by preoperative coronary angiography. The mass was successfully excised and the diagnosis of cardiac myxoma was confirmed via histopathology. A review of the value of coronary angiography in detecting myxoma neovascularization is provided. Offering additional valuable information, coronary angiography can alter the surgical approach and may therefore be considered prior to myxoma resection.

Acute Respiratory Distress after Knee Arthroplasty Due to Undiagnosed Atrial Myxoma

Acute postoperative respiratory distress may be caused by pneumonia, pulmonary embolism, heart failure, pneumothorax or atelectasis. We present s case report of a 78-year-old female patient who developed acute respiratory distress one day following knee arthroscopy. Because of the suspicion of pulmonary embolism, a computed tomographic angiography was made, showing the presence of an unexpected large left atrial mass, suggestive for a myxoma. She underwent successful resection of a 10 × 5 cm myxoma one week later. The report discusses the clinical manifestations of an atrial myxoma and its potentially fast growth. Bedside echocardiography should be considered the preferred diagnostic modality in case of acute postoperative respiratory distress.

Giant Left Atrial Myxoma in an Elderly Man: Case Report

Left atrial myxomas (LAM), the most common primary tumours of the heart are unusual or rare in the elderly. Moreover, elderly patients often present with non-specific symptoms that are frequently overlooked in the absence of a supporting cardiac history which makes an early diagnosis challenging. Herein, we reported large LAM in 70-year-old Iraqi Kurdish male who was presented with minimal obstructive symptoms and the diagnosis was not suspected clinically but discovered by trans-thoracic echocardiography (TTE) followed by successful surgical excision. Although atrial myxomas are benign, they have potential serious complications which mandate prompt therapy. Due to low morbidity and mortality besides its excellent outcome even in the elderly, surgery is the preferred choice of treatment for LAMs.

An unusual combination of left atrial myxoma and left ventricular non-compaction cardiomyopathy in a male patient:A Casereport

Left atrialmyxoma is a common primary cardiac tumor that is accompanied by organic heart diseases.But left atrial myxoma coexistent with left ventricular non-compaction(LVNC)is extremely rare.A young male patient with left atrial myxoma and LVNC was reported in this study.A 25-year-old manpresented to the emergency department with sudden shortness of breath and syncope,accompanied by fever and cough.He had a history ofacute ischemic strokeone year before hospitalization.Echocardiography revealed that the endocardium of the left ventricle was not smooth with raised muscle trabeculae and deep recesses.There was an oval-shaped strong echo mass with a pedicle in the left atrium attached to the atrial septum.Tumor resection was operated during extracorporeal circulation.Pathological results confirmed left atrium myxoma.In this case report,the patient had heart failure and an ischemic stroke likely of cardiogenic origin.He underwenttumor resection and started on therapeutic anticoagulation.Left atrial myxoma and LVNC are associated with poor outcomes.Early diagnosis and prompt treatment are crucial.

A giant cyst-like mass： an unusual morphous of left atrial myxoma

Primary cardiac neoplasms are very rare as compared to metastatic tumors; 70% to 80% of them are benign myxomas. Myxomas are polypoid, round, or oval. They are gelatinous with a smooth or lobulated surface, usually white, yellowish, or brown. We report a case of left atrial myxoma with approximate cystis in morphous.

Synchronous left atrial myxoma and adenosquamous lung carcinoma

Atrial myxomas account for 40%-50% of primary cardiac tumors and as such are the most common primary heart tumors. Because prolapsing myxomas cause the intermittent obstruction of the valvular outflow tract during diastole, the signs and symptoms of left atrial myxoma resemble mitral stenosis. Myxoma may lead to systemic thromboembolic events from tumor fragmentation. In addition, lung carcinoma is a common tumor with highly heterogeneous malignancies.

Anticoagulation therapy for pulmonary embolism involving a myxoma mimicking, giant type C thrombus: A case report

Right heart thrombus(RHTh) with concurrent acute pulmonary embolism(PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh(type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography(TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh.

Pulmonary embolism due to the right atrial thrombus mymicking atrial myxoma

Detection of a cardiac mass has a direct therapeutic implication because of its potential for pulmonary or systemic embolization. The choice of treatment is dependent upon the time of the embolization, clinical presentation and type of embolic mass. Imaging features in combination with clinical and laboratory findings are usually helpful in the differentiation of various cardiac masses with high probability. The case we are presenting is a 73-year-old man with occlusion of both pulmonary arteries and a right atrial thrombus initially diagnosed as a myxoma.

Right Atrial Giant Myxoma Occupying the Right Ventricular Cavity

Introduction: Atrial myxomas are the most common primary heart tumors. Because of nonspecific symptoms, early diagnosis may be a challenge [1] [2]. Left atrial myxoma may or may not produce characteristic findings on auscultation. Two-dimensional echocardiography is the diagnostic procedure of choice. Most atrial myxomas are benign and can be removed by surgical resection. Cardiac myxoma is located mostly in left atrium [3]. This was amazing huge mass of cardiac myxoma in unusual part of the heart with the patient showed significant response to anticoagulation after presumed recurrence of tumor. Case Presentation: A case of giant right atrial myxoma mimicking the right ventricular tumor is described. Surgery was performed in 41 years old female and the fist like tumor with its stalk was excised. Surprisingly it recurred after 2 month as the smaller tumor was completely resolved with anticoagulation therapy. In addition because of previous normal echocardiography that was done for another reasons, we estimated the speed of tumor’s growth (3 millimeter/month). Conclusion: To sum up a very large myxoma in right ventricle may only present with occasional dyspnea and we can diagnose it with precise evaluation and with performing on time echocardiography.

The feasibility, effectiveness and safety of totally thoracoscopic resection for right atrial myxoma

Background Myxoma is the most frequent cardiac benign tumor which requires surgical removal even though in right atrium. Minimally invasive surgery has become the standard approach for removal of myxoma in our center. Herein, we report our initial experience of cardiac myxoma removal through mini-port totally thoracoscopic particular with focus on its feasibility, efficacy and short-term outcomes, as compared with median sternotomy. Methods From April 2015 to March 2019, 31 consecutive cases were ultimately identified and divided into two groups(Mini-port thoracoscopic group, n=14;versus conventional median sternotomic group, n=17). An echocardiography was routinely performed prior to discharge, at 1 st month, 6 th month, 12 th month and every year postoperatively. Retrospective analyses of perioperative data, postoperative outcomes and complications,and follow up data were performed. Results All the 31 patients successfully underwent right atrial myxoma removal surgery with no perioperative death, re-exploration for bleeding, residual mass or central nervous event in both groups. Intraoperative data from two group showed absence of significant difference except the intraoperative blood loss(150±50.01 m L in mini-port thoracoscopic group vs. 255.88±93.35 m L in conventional median sternomtomic group, P=0.01). There was no significant difference in perioperative blood transfusion and postoperative outcomes between the two groups. But the mini-port thoracoscopic group had a much less 24-hour postoperative drainage(136.71±148.20 m L vs. 341.17±211.29 m L, P=0.03). No significance difference could be identified between two groups about the incidence of postoperative morbidities and follow-up adverse events. Conclusion Totally mini-port video-assisted thoracoscopic approach for right atrial myxoma resection on peripheral cardiopulmonary bypass is feasible, effective with favorable safety in experienced cardiac center.[S Chin J Cardiol 2019;20(4):236-244]

Six Years Clinical Experience and Surgical Considerations in Management of Cardiac Myxoma in Iraqi Center for Heart Disease—Single Center Experience

Background: Cardiac myxomas are the most frequently encountered benign cardiac tumors that if left untreated are inexorably progressive and potentially fatal. Surgery is the only way of treatment, and if not treated with the right surgical technique recurrence occurs. Objectives: In this single center study we documented the patterns of presentation, localization, surgical approaches and outcome of cardiac myxomas. Methods: This is a retrospective study of 20 patients who underwent surgical removal of atrial myxoma from January 2010 to December 2015. All patients underwent general investigations, and echocardiography was performed on all patients and surgery was done using extracorporeal circulation and mild hypothermia. Results: The ages of the patients ranged from 14 years to 71 years, with a mean of 51.45 years. Most myxomas (75%) originated from left atrium, 20% from right atrium and biatrial in 5% of cases. The male-to-female ratio was 1:2.3 (14 females and 6 males). Myxomas were more common in blood group A+ and B+. Chief complaints were dyspnea (70%) and palpitation (50%). The majority of masses were attached to the interatrial septum (65%) and four of cases (20%) arose from the lateral wall. Right atrial trans-septal incision was used in 55% of cases. No recurrence was recorded in our study. Six patients had postoperative complications, mainly in the form of arrhythmia (3 cases), bleeding (0ne case) and renal failure (one case) which resulted in the death of the patient. Conclusions: Cardiac myxoma excision account for a very small percentage of cardiac procedures. Immediate surgical treatment is indicated because of high risk of embolization and sudden death. Cardiac myxomas can be excised with a low rate of mortality and morbidity. Follow-up examination, including echocardiography, should be performed regularly.

Left ventricular myxoma:Missed vs metastatic

Left ventricular myxomas account for 2.5% of all cardiac myxoma cases.There are very few case reports on left ventricular myxoma(LVM) presented after complete surgical resection of left atrial myxoma.Here we report a case of a 58-year-old male presented to the hospital for transient limb weakness,numbness and dysarthria.Magnetic resonance image of the brain revealed multiple thromboembolic cerebrovascular accidents.Transthoracic echocardiogram(TTE) revealed a left atrial myxoma.It was resected completely with good surgical margins.After one and half year he started having dizziness,and transient right sided weakness.Computer tomography scan of the head revealed a progression of thromboembolic disease.TTE revealed a LVM that was confirmed by transesophageal echocardiogram.It was resected with good surgical margins 3 wk after recurrent cerebrovascular accident.

全胸腔镜下左心房黏液瘤切除15例

目的 总结15 例全胸腔镜左房黏液瘤切除术的初步经验,探讨全胸腔镜下心内手术的安全性和适应证.方法 2012年1 月至2013 年10 月,收治15例左房黏液瘤患者,女性10 例,男性5 例,其中5例合并二尖瓣关闭不全行二尖瓣成型术.全身麻醉下,双腔气管插管,采用股动静脉插管、右侧颈内静脉引流进行体外循环.右侧胸壁3个1～2 cm切口,在全胸腔镜下行左房黏液瘤切除术.结果 15 例手术均顺利进行.1例因瘤蒂位于左房底,瘤体大暴露困难,正中切口开胸手术,其余均全腔镜下完成手术.体外循环（40±15）min,升主动脉阻断（30±12）min,术后呼吸机辅助（4.5±1.4）h,术后住院（5.6±1.3）d.无大出血、术后再次开胸止血、脑栓塞等并发症.术后病理检查,1例为左房肉瘤,其余均为左房黏液瘤.结论 全胸腔镜左房黏液瘤切除技术可行、安全,既减少了常规正中开胸的手术创伤,又没有过度延长体外循环时间造成的进一步全身器官损害,有利于患者的术后早日康复,手术切口小、美观.

超声心动图诊断右心房黏液瘤

目的探寻右心房黏液瘤的超声特点,评价超声心动图对右心房黏液瘤的诊断价值。方法回顾分析20例右心房黏液瘤的超声表现,总结右心房黏液瘤的超声心动图特点。结果右心房黏液瘤的临床症状主要有胸闷、气短、下肢浮肿及晕厥等。超声测量瘤体大小为3.11 cm×2.90 cm^7.44 cm×4.52 cm,形态为类圆形或分叶状。瘤蒂附着于房间隔者占75%,附着于右心房游离壁者占25%。瘤蒂平均宽度为(1.62±0.30)cm,宽度大于1 cm者占80%。部分黏液瘤内部可见钙化和囊状无回声区。右心房内血流阻塞占70%,三尖瓣狭窄占50%,肺高压者占10%。结论超声心动图可以准确评价右心房黏液瘤瘤体特点及继发心内结构和血流动力学改变,为临床作出及时、准确诊断提供重要依据。

心脏黏液瘤的临床及超声特点探讨

目的探讨心脏黏液瘤的临床及超声特点。方法选取11例心脏黏液瘤患者,男5例、女6例,行多普勒超声检查,均经手术和病理证实,分析患者的临床特点及超声特点。结果 11例患者的临床表现包括胸闷、心悸、发热、晕厥、脑梗死、心律失常等,体征包括舒张期杂音、双期杂音、肿瘤扑落音等。11例患者均为单发,左房多见,超声表现为心房内稍高回声团块,边界清晰,部分呈分叶状,大部分内部回声较均匀,多数瘤体有蒂附着于房间隔上,随心动周期规律摆动,同时并发心房增大,下腔静脉增宽等。结论心脏黏液瘤临床表现个体差异极大,但超声表现较为典型,可以作为该病的首选检查方式。

心房粘液瘤21例分析

目的探讨心房粘液瘤的诊断和外科治疗。方法21例心房粘液瘤均经B超确诊,在全身麻醉、中度低体温体外循环下进行手术切除。结果体外循环时间38～98min,平均45±12.4min,主动脉阻断时间29～78min,平均34±11.3min,实行左房粘液瘤切除15例,右房粘液瘤切除6例,无围手术期死亡,均痊愈出院。术后随访2年,1例复发,二次手术治愈。结论心房粘液瘤确诊后应尽早手术治疗,术中应加强心肌保护,术中完整切除瘤体,避免肿瘤复发。

原发性心脏肿瘤26例临床分析

本文对26例原发性心脏肿病进行了临床分析.良性者21例,其中有20例为心房粘液瘤,1例为毛细血管瘤.恶性肿瘤有5例.临床表现、X线和ECG检查类似二尖瓣和三尖瓣病.5例原发性恶性肿瘤表现缺乏特异性,但发热、食欲减退和体重减轻相当明显,并以大量心包积液为突出表现.超声心动图(u,n,G)对心脏肿瘤的诊断有很重要的价值,手术切除为首选治疗方法.