Management of Cardiac Myxomas

Abstract

Cardiac myxomas are benign primary tumors of the heart that require prompt surgical intervention because of the possibility of developing syncope and hemodynamic or embolic complications. From 1 January 1981 to 31 December 1996, 20 patients (11 male and 9 female) underwent surgery for cardiac myxoma at Singapore General Hospital. Nineteen patients had a left atrial myxoma and 1 had a right atrial myxoma. Five patients had concomitant coronary artery disease including one with severe mitral regurgitation. Nine patients presented with progressive dyspnea, 5 with systemic embolus, 2 with syncope, 3 with congestive cardiac failure, and 1 with right ventricular failure. In 6 patients the diagnosis was established by cardiac catheterization and 14 patients were diagnosed by two-dimensional echocardiography. Cardiopulmonary bypass with mild to moderate systemic hypothermia was used for excision of the myxoma in all cases. Five patients had concomitant coronary artery bypass grafting and 2 had concomitant mitral valve replacement. There was no hospital mortality among patients who had only excision of the myxoma, including a patient who had a recurrence of her left atrial myxoma 5 years after the initial excision. There were 2 deaths in patients with coexisting cardiac and other diseases. Surgical excision is recommended for all cases of cardiac myxoma. There is little risk associated with this procedure. All patients should be followed up regularly with echocardiographic assessment as there is a small risk of recurrence.