Atrial myxoma: a review

Ishtyak Ahmed Mir; Abdul Ghani Ahangar

doi:10.18203/2394-6040.ijcmph20151479

Authors

Ishtyak Ahmed Mir Department of Cardiovascular and Thoracic Surgery, Super Specialty Hospital, GMC Jammu, J & K
Abdul Ghani Ahangar NEIGRIHMS, Shillong, Meghalaya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20151479

Keywords:

Left atrium, Myxoma

Abstract

A seemingly benign and rare condition atrial myxoma can present with a grim phenomenon if the presentation is late or the diagnosis and surgery is delayed. Females in 3^rd to 5^th decade of life are the common sufferers, but no age is exempt. Patients may present with dyspnea, palpitation, embolization, congestive heart failure, neurologic symptoms, systemic illness, pain chest/limbs, pyrexia or weight loss. Clinical examination may reveal accentuated apical first heart sound, systolic murmur, tumor plop, loud pulmonic component, anaemia, asthenia, hypertension, paresis or plegia of limbs, or sudden cardiac arrest. Symptomatology and clinical signs may be misleading and the diagnosis is made by transthoracic echocardiography. Transesophageal echocardiography though invasive is superior to transthoracic echocardiography. Patients presenting with peripheral embolization need doppler studies, computed tomography. Magnetic resonance imaging may be needed to differentiate atrial myxoma from other cardiac tumors. Early surgical intervention for atrial myxomas which is done on urgent basis mitigates morbidity and usually offers cure. Jugular cannulation is avoided, heart is approached by median sternotomy but right anterior thoracotomy is equally good. Cannulation is done gently and aorta cross clamped before cardioplegia, right atriotomy approach is sufficient to remove the whole tumor along with its base and adjacent septal wall. Thorough saline irrigation / suction of atrium and ventricle remove all the tumor emboli. The defect so created is repaired directly or with a patch. Recurrence may be there but the Long term results are excellent. If asymptomatic, high risk patients should be followed with echocardiographic examination.

Metrics

Metrics Loading ...

References

Strauss R, Merliss R. Primary tumors of the heart. Arch Pathol. 1945;39:74-80.

Shelburne SA. Primary tumors of the heart. Ann Intern Med. 1935;9(3):340-9.

Silverman NA. Primary cardiac tumors. Ann Surgery. 1980;191:127.

Columbus MR. De Re Anatomica, Libri XV. Paris, 1562.

Yater WM. Tumors of the heart and pericardium pathology sympatomatology and report of 9 cases. Arch Intern Med. 1931;48:267.

Reynen K. Cardiac myxomas. N Engl J Med. 1995;333:1610-7.

McAllister HA Jr. Primary tumors of the heart and pericardium. Pathol Annu. 1979;14:325-55.

Greenwood WF. Profile of atrial myxoma. Am J Cardiol. 1968;21:367.

Penny JL, Gregory JJ, Ayres SM, Giannelli S jr, Rossi P. Calcified left atrial myxoma simulating mitral insufficiency. Hemodynamic and phonocardiographic effects of tumor movements. Circulation. 1967;36;417.

Mundinger A, Gruber HP, Dinkel E. Immaging cardiac mass lesions. Radiol Med. 1992;10:135-40.

Dressler FA, Labovitz AJ. Systemic arterial emboli and cardiac masses. Card Clin. 1993;11:447-60.

Ensberding R, Daniel WG, Erbel DR, Kaspar W, Lestuzzi C, Curtis JM, et al. Diagnosis of heart tumors by transesophageal echocardiography: a multicentric study in 154 patients. Eur Heart J. 1993;14(9):1223-8.

Semb BKH: Surgical consideration in the treatment of cardiac myxoma. J Thorac Cardiovasc Surg. 1984;87:251-9.

Bortolotti U, Mazzucco A, Valfre C, Velente M, Pannelli N, Gallucci V: Right ventricular myxoma: Review of the literature and report of two patients. Ann Thorac Surg 1982; 33: 277-84.

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.

Castells E, Ferran V, Octavio de Toledo MC, Calbet JM, Benito M, Fontanillas C, et al: Cardiac myxoma: Surgical treatment, long term results and recurrence. J Cardiovasc Surg. 1993;34(1):49-53.

Guiloff AK, Flege JB, Callard GM, Dunn EJ, Wilson JM, Wright CB; Surgery of left atrial myxomas: report of eleven cases and review of literature. J cardiovasc Surg. 1986;27(2):194-200.

Murphy MC, Sweeney MS, Putnam JB,Walker WE, Frazier OH, Ott DA, et al. Surgical treatment of cardiac tumors: A 25 years’ experience. Ann thorac Surg. 1990;49:612-8.

Miralles A, Bracamonte L, Soncul H, Diaz del Castillo R, Akhtar R, Bors V, et al. Cardiac tumors: Clinical; experience and surgical results in 74 patients. Ann Thorac Surg. 1991;52(4):886-95.

Donahoo JS, Weiss JL, Gardner TJ, Fortuin NJ, Brawley RK. Current management of atrial myxoma with emphasis on a new diagnostic technique. Ann Surg. 1979;189(6):763-8.

McCarthy PM, Piehler JM, Schaff HV, Pluth JR, Orszulak TA, Vidaillet HJ Jr, et al. The significance of multiple, recurrent, and “complex” cardiac myxoma. J Thorac Cardiovasc Surg. 1986;91:389.

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.

O’Neil MB, Grehl TM, Hurley EJ. Cardiac myxoma: A clinical diagnostic challenge. Am J Surg. 1979;138:68.

Krikler DM, Rode J, Davies MJ, Woolf N, Moss E. Atrial myxoma: a tumor in search of its origin. Br Heart J. 1992;67:89.

Wold LE, Lie JT. Scanning electron microscopy of intracardiac myxoma. Mayo Clin Proc. 1981;56:198.

Merkow LP, Kooros MA, Magovern G, Hayeslip DW, Weikers NJ, Pardo M, et al. Ultrastructure of a cardiac myxoma. Arch pathol. 1969;88:390.

Richardson JV, Brandt B, Doty DB, Ehrenhaft JL: Surgical treatment of atrial myxoma: Early and late results of 11 operations and review of literature. Ann Thorac Surg. 1979;28:354-8.

Livi U, Bortolotti U, Milano A,Valente M, Prandi A, frugoni C, et al. Cardiac myxomas: Results of 14 years experience. J Thorac Cardiovasc Surg. 1984;32(3):143-7.

Gray IR, Williams WJ. Recurring cardiac myxoma. Br Heart J. 1985;53:645.

David C. Cleveland, Stephen Westaby, Robert B. Karp. Treatment of interatrial Cardiac Tumors. JAMA. 1983;249(20):2799-802.

King TW. On simple vascular growths in the left ventricle of heart. Lancet. 1845;2:428-9.

Barnes AR, Beaver DC, Snell Amp. Primary sarcoma of the heart: report of a case with electrocardiographic and pathological studies. Am Heart J. 1934;9:480.

Goldberg HP, Glenn F, Dotter Ct, Steinberg I. Myxoma of the left atrium: Diagnosis made during life with operative and post mortem findings. Circulation 1952; 6: 762.

Frnak W. Selke, John H. Lemmer, Byron F. Vandenberg, Johnn L. Ehrenhaft. Surgical treatment of cardiac myxoma: long term results. Ann Thorac Surg. 1990;50:557-61.

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.

Manoj Agny, Mark Reller, Adnan Cobanoglu. Tricuspid valve myxoma in a pediatric patient: 10 year follow after resection. Ann Thorac Surg. 1999;67:1803-4.

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.

Peachell JL, Mullen JC, Bently MJ. Biatrial Myxoma: A Rare Cardiac Tumor. Ann Thorac Surg. 1998;67:1768-9.

Padhy K, Krishnagopal K, Sabanayagam N, Pereira IP, Nachiappan M. Atrial Myxoma: 8 year JIPMER Experience. IJTCVS. 2001;17:230-2.

Goodwin JF. Spectrum of cardiac tumors. Am J cardio. 1968;21:307.

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.

Tipton BK, Robertson JT, Robertson JH. Embolism to the central nervous system from cardiac myxoma: report of two cases. J Neurosurg. 1977;47:937.

Symbas PN, Hatcher CR, Gravanis MB. Myxoma of the heart: Clinical and experimental observations. Ann Surg. 1976;183:470.

Peter MN, Hall RJ, Cooley DA, Leachman RD, Garcia E. The clinical syndrome of atrial myxoma: JAMA. 1974;230(5):695-701.

Diflo T, Cantelmo NL, Haudenschild CC, Watkins MT. Atrial myxoma with remote metastasis. Case report and review of literature. Surgery. 1992;111(3):352-6.

Misago N, Tanaka T, Hoshii T, Suda H, Itoh T. Erythematous papule in a patient with cardiac myxoma: a case report and review of literature. J dermatol. 1995;22(8):600-5.

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.

Tighe DA, Rousou JA, Kenia S, Kulshrestha P. Transesophageal echocardiography in the management of mitral valve myxoma. Am Heart J. 1995;130:627-9.

Dressler FA, Laboritz AJ. Systemic arterial emboli and cardiac masses. Card Clin. 1993;11:447-60.

Reeder GS, Khandheria BK, Seward JB, Tajik AJ. Transesophageal echocardiography and cardiac masses. Mayo Clin Proc. 1991;66:1101-9.

Massetti M, Babatasi G, Page OL, Bhoyroo S, Khayat A. Modified Biatrial Apprach for the Extensive Resection of Left Atrial Myxomas. 1998;66:275-6.

Chitwood WR. Cardiac neoplasms: current diagnosis, pathology and treatment. J Cardiol Surg. 1988;3:119-54.

Mc Allister HA, Fenoglio JJ. Tumors of the Cardiovascular system: Fascicle 15 Atlas of Tumor Pathology, Second Series. Washington DC, Armed Forces Institute of Pathology, 1978.

Carney JA. Differences between nonfamilial and familial cardiac myxoma. Am J Surg Pathol. 1985;9:53.

Kamli MA, Ahangar AG, Ahmed N, Ali G, Rasheed S, Allaqaband GQ. A giant right atrial myxoma. JK Practitioner. 1997;4:116-8.

Sasaki S, Lin YT, Redington JV, Mendiz AM, Zubiate P, Kay JH. Primary intracavitory heart tumors: a review of 11 surgical cases. J Cardiovasc Surg. 1977;18:15.

Clevaland DC, Wstaby S, Karp RB. Treatment of intra-atrial cardiac tumors. JAMA. 1983;249:2799.

Asmor B, Acker M, Couetil JP, Penther PH, Carpentier A. et al. Tricuspid valve myxoma: a rare indication for tricuspid valve repair. Ann Thorac Surg. 1991;52(6):1315-6.

Bahnson HT, Newman EV. Diagnosis and surgical removal of intracavitory myxoma of the right atrium. Bull Johns Hopkins Hosp. 1953;93:150.

Coates EO, Drake EH. Myxoma of the right atrium with variable right to left shunt: Clinical and physiological observation and report of a case with successful operative removal. N Engl J Med. 1958;259:165.

Meyns B, Vanclemmput J, Flameng W, Daemen W. Surgery for cardiac myxoma; A 20 year experience with long term follow up. Eur J Cardiothorac Surg. 1993;7:437-40.

Bjessmo S, Inert T. Cardiac myxoma: 40 years experience in 63 patients. Ann Thorac Surg. 1997;63:697-7.

Pinede L, Duhaut P, Loire R. Clinical presentation left atrial myxoma. A series of 112 consecutive cases. Medicine (Baltimore). 2001;80(3):159-72.

Hanson EC, Gill CC, Razari M, Loop FD. The surgical treatment of atrial myxoma: Clinical experience and late results in 33 patients. J Thorac Cardiovasc Surg. 1985;89:298.

Firor WB, Aldridge HE, Biglow WG. A follow study of three patients after removal of left atrial myxoma 5 to 10 years previously. J Thorac Cardiovasc Surg. 1966;51:515.

Ko PJ, Chang CH, Lin PJ, Chu JJ, Tsai FC, Hsueh C, et al. Video assisted minimal access in excision of left atrial mycoma. Ann Thorac Surg. 1998;66:1301-5.

Panos A, Myers PO. Video assisted cardiac resection: basket technique fr complete and safe removal from the heart. Ann Thorac Surg. 2012;93:e109-10.

Schilling J, Engel AM, Hassan M, Smith JM. Robotic excision of atrial myxoma. J Card Surg. 2012;27:423-6.

Pineda AM, Santana O, Zamora C, Benjo AM, Lamas GA, Lamelas J. Outcome of a minimally invasive approach compared with median sternotomy for the excision of benign cardiac masses. Ann Thorac Surg. 2012;91:1440-4.

Russo MJ, Martens TP, Hong KN, Colman DL, Voleti VB, Smith CR, et al. Minimally invasive versus standard approach for excision of atrial masses. Heart Surg Form. 2007;10:E50-4.

Iribarne A, Easterwood R, Russo MJ, Yang J, Cheema FH, Smith CR, et al. Long term outcomes with a minimally invasive approach for resection of cardiac masses. Ann Thorac Surg. 2010; 90:1251-5.

Bossert T, Gummert JF, Battellini R, Rishter M, Barten M, Walther T, et al. Surgical experience with 77 primary cardiac tumors. Interact CardioVasc Thorac Surg. 2005;4:311-5.

Ravikumar E, Pawar N, Gnanamuthu R, Sundar P, Cherian M, Thomas S. Minimal access approach for surgical management of cardiac tumors. Ann Thorac Surg. 2000;70:1077-9.

Vistarini N, Alloni A, Aiello M, Vigano M. Minimally invasive video-assisted approach for left atrial myxoma resection. Interact CardioVasc Thorac Surg. 2010;10:9-11.

Lone RA, Ahangar AG, Singh S, Masood W, Shah S, Lone GN, et al. Atrial Myxoma: trends in Management. Int J Health Sci (Qassim). 2008;2(2):141-51.

Lone RA, Ahangar AG, Wani ML, Dar AM, , Singh S, Hussain Z, et al. A frequently found tumor at high altitude: Atrial myxoma; Kashmir experience. Saudi Journal of Health Sciences. 2012;1(2):69-73.

Ishtyak Ahmed Mir, Abdul Gani Ahangar. Comparison of thoracotomy with median sternotomy approach for intracardiac operations. Journal of Medical Science and Clinical Research. 2015;3(9):7377-84.

Mir IA, Ahangar AG. Right thoracotomy approach for open heart surgery. International Journal of Research in Medical Sciences. 2015;3(11):3021-6.