Cardiac Myxomas: Clinical spectrum, investigation findings, and surgical treatment based on our 25-year-experiences

Objectives: The aim of this study was to describe the clinical spectrum, investigation findings, and surgical treatment of cardiac myxomas. Patients and methods: Between November 1991 and July 2016, 229 patients (99 males, 130 females; mean age 37.1 years; range 7 to 63 years) with a primary or recurrent intra-cardiac myxoma underwent surgical excision at our institute. The diagnosis was made by transthoracic and transesophageal echocardiography. The basic surgical principle of complete wide excision was applied, and either unicameral (right or left atrial approach) or bicameral (both atria opened) surgical approach was used. Myxomas originating from the valve or valve annulus required a special attention. Postoperative echocardiograms were obtained in all patients before discharge. All patients were followed at three and 18 months, and five years postoperatively. Results: The most common presenting symptoms were dyspnea and palpitation. There were 197 left atrial, 27 right atrial, two left ventricular, and one each of right ventricular, right ventricular outflow tract and multiple myxomas. There were three early death events; however no late mortality was seen. During follow-up, all patients were in the New York Heart Association Class I and echocardiography showed good ventricular functions with normal pulmonary artery pressure. Seven patients developed sporadic recurrence of myxoma. The valves were competent in the patients who underwent valve repair. Conclusion: Based on our experience, we recommend the left atriotomy approach for left atrial myxomas and the right atriotomy approach for dumbbell-shaped left atrial and right atrial myxomas. Biatrial approach should be used in large and unusually located left atrial myxomas, while individualized approaches should be performed for others. To prevent recurrence, the surgical excision must include a substantial portion of normal endocardium near the base of implantation. The early mortality is commonly seen due to coronary embolism, and the late survival of patients after myxoma excision is usually excellent.