Atrial Myxomas: A Single Unit's Experience in the Modern Era

Authors

  • Corinne E. Owers
  • Paul Vaughan
  • Peter C. Braidley
  • Glen A. L. Wilkinson
  • Timothy J. Locke
  • Graham J. Cooper
  • Norman P. Briffa
  • David N. Hopkinson
  • Pradip K. Sarkar

DOI:

https://doi.org/10.1532/HSF98.20091163

Abstract

Background: Although an atrial myxoma is the commonest cardiac tumor, it is still relatively rare, with an annual incidence of approximately 0.5 per million. In our unit, which performs 1000 major cardiac procedures per year, this equates to approximately 3 patients annually. We therefore sought to evaluate our experience of managing this type of tumor over the last 5 years.

Methods: A retrospective review was performed of prospectively collected data from the departmental database. We analyzed consecutive patients who were operated upon between 2002 and 2007. Three patients with a papillary fibroelastoma on histological examination were excluded from this study.

Results: We have performed excision of atrial myxoma in 18 patients. Twelve patients (66%) were female; the median age was 64 years (range, 35-80 years), and the median logistic euroSCORE was 5.22% (range, 1.51-27.82%). Fifteen patients (83%) were deemed urgent, 2 elective, and 1 emergency. Sixteen tumors (89%) were left sided. Symptoms attributable to the tumor were found in 16 of the 18 patients (embolic, n = 9; chest pain, n = 3; palpitations, n = 2; incidental finding, n = 2, others n = 4), and the mean time from diagnosis to operation was 3 days (range, 0-22 months). The median cardiopulmonary bypass time was 87 minutes (range, 28-228 minutes), with the median aortic cross clamp time being 61 minutes (16-175 minutes).

The approaches used were transeptal via right atriotomy (n = 8), biatrial/Dubost (n = 4), left atrial (n = 4), and right atrial (n = 2); the interatrial septum was involved in 14 patients. The resultant defect was closed using a pericardial (n = 8) or prosthetic patch (n = 5) or directly sutured (n = 5). Concomitant procedures were performed in 8 patients (coronary artery bypass graft [CABG], n = 4; mitral valve replacement [MVR], n = 2; valve + grafts, n = 2). All tumors were completely excised.

Postoperatively there were no deaths within 30 days of the procedure. Indeed, only 2 patients have died at 4 and 25 months postoperatively, respectively, both of unrelated causes. Median intensive therapy unit (ITU) stay was 2 days (range, 1-9 days), and median hospital stay was 10 days (range, 5-20 days). A permanent pacemaker was required in only 1 patient, and median blood loss was 340 mL (range, 140-1760 mL). Atrial fibrillation was the commonest complication affecting 6/18 patients (33%).

Conclusions: Excision of atrial myxoma can be performed using a variety of intraoperative approaches and closure techniques, all with acceptable postoperative morbidity and low mortality rates. To date, no recurrences have been found at median 2-year follow-up.

References

Álvarez-Sabín J, Lozano M, Sastre-Garriga J, et al. 2001. Transient ischaemic attack: a common initial manifestation of cardiac myxomas. Eur Neurol 45:165-70.nCastells E, Ferran V, Octavio de Toledo MC, et al. 1993. Cardiac myxomas: surgical treatment, long-term results and recurrence. J Cardiovasc Surg (Torino) 34:49-53.nChitwood WR Jr, Nifong LW. 2003. Minimally invasive and robotic valve surgery. In: Cohn LH, Edmunds LH, eds. Cardiac Surgery in the Adult. 2nd ed. New York: McGraw-Hill: 1075-92.nChristiansen S, Stypmann J, Tjan TD, et al. 1999. Minimally-invasive versus conventional aortic valve replacement—perioperative course and mid-term results. Eur J Cardiothorac Surg 16:647-52.nDaniel WG, Mügge A. 1995. Transesophageal echocardiography. N Engl J Med 332:1268-79.nEngberding R, Daniel WG, Erbel R, et al. 1993. Diagnosis of heart tumours by transoesophageal echocardiography: a multicentre study in 154 patients. European Cooperative Study Group. Eur Heart J 14:1223-8.nGillinov AM, Banbury MK, Cosgrove DM. 2000. Hemisternotomy approach for aortic and mitral valve surgery. J Card Surg 15:15-20.nGoodwin JF. 1968. The spectrum of cardiac tumors. Am J Cardiol 21:307-14.nJanas R, Jutley RS, Fenton P, Sarkar P. 2006. Should we perform preoperative coronary angiography in all cases of atrial myxoma? Catheter Cardiovasc Interv 67:379-83.nKeeling IM, Oberwalder P, Anelli-Monti M, et al. 2002. Cardiac myxomas: 24 years of experience in 49 patients. Eur J Cardiothorac Surg 22:971-7.nKnepper LE, Biller J, Adams HP Jr, Bruno A. 1988. Neurologic manifestations of atrial myxoma: a 12-year experience and review. Stroke 19:1435-40.nLijoi A, Scoti P, Faveto C, et al. 1993. Surgical management of intracardiac myxomas. A 16-year experience. Tex Heart Inst J 20:231-4.nMacGowan SW, Sidhu P, Aherne T, et al. 1993. Atrial myxoma: national incidence, diagnosis and surgical management. Ir J Med Sci 162:223-6.nMächler HE, Bergmann P, Anelli-Monti M, et al. 1999. Minimally invasive versus conventional aortic valve operations: a prospective study in 120 patients. Ann Thorac Surg 67:1001-5.nMeyns J, Vancleemput J, Flameng W, Daenen W. 1993. Surgery for cardiac myxoma: a 20-year experience with long-term follow-up. Eur J Cardiothorac Surg 7:437-40.nReynen K. 1995. Cardiac myxomas. N Engl J Med 333:1610-7.nSingh RN, Burkholder JA, Magovern GJ. 1984. Coronary arteriography as an aid in left atrial myxoma diagnosis. Cardiovasc Intervent Radiol 7:40-3.nSkanse B, Bava NO, Westfelt L. 1959. Atrial myxoma with Raynaud's phenomenon as the initial symptom. Acta Medica Scand 164:321-4.nStevens LM, Lapierre H, Pellerin M, et al. 2003. Atrial versus biatrial approaches for cardiac myxomas. Interact Cardiovasc Thorac Surg 2:521-5.nSt John Sutton MG, Mercier LA, Giuliani ER, Lie JT. 1980. Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Proc 55:371-6.nTazelaar HD, Locke TJ, McGregor CG. 1992. Pathology of surgically excised primary cardiac tumors. Mayo Clin Proc 67:957-65.nVeitch AM, Manghat NE, Kakani NK, Lewis CT, Ring NJ. 2006. Systemic septic embolisation secondary to an atrial myxoma in a young woman. Emerg Radiol 12:137-9.nWalkes JCM, Smythe WR, Reardon MJ. 2008. Cardiac neoplasms. In: Cohn LH, ed. Cardiac Surgery in the Adult. 3rd ed. New York: McGraw-Hill: 1479-510.nYu SH, Lim SH, Hong YS, Yoo KJ, Chang BC, Kang MS. 2006. Clinical experiences of cardiac myxoma. Yonsei Med J 47:367-71.n

Published

2012-02-03

How to Cite

Owers, C. E., Vaughan, P., Braidley, P. C., Wilkinson, G. A. L., Locke, T. J., Cooper, G. J., Briffa, N. P., Hopkinson, D. N., & Sarkar, P. K. (2012). Atrial Myxomas: A Single Unit’s Experience in the Modern Era. The Heart Surgery Forum, 14(2), E105-E109. https://doi.org/10.1532/HSF98.20091163

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