Atrial myxoma: a review

Abstract

The prevalence of primary tumors of the heart in autopsy series has been reported between 0.007, 0.35 to 0.3 percent. 1-3 Though the first report of a cardiac tumor appeared in 1559, little headway had been made in the overall diagnosis and management of such a disease. 4 It was only in 1931 that the first extensive review of the literature was made and a useful classification of the system designed. 5 Three quarter of the tumors are benign and nearly half the benign tumors are myxomas. 6 Commonly observed tumors are myxomas which are globular in shape, have a soft, gelatinous consistency, exhibit a yellow-brown or greenish hue and often contain areas of hemorrhage and necrosis. They usually have short broad-based attachment but can be sessile. Papillary forms may have a fond-like surface that is friable making emboli more likely. 7 Myxomas are exclusively intracavitarily and are rarely seen deeper then endocardium on histological sections. 3

Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma?

“…Cardiac myxoma is the most common primary cardiac tumor in adults and accounts for half of the primary cardiac neoplasms. Females in the third to fifth decade of life are the common sufferers and about 75% of cardiac myxomas are located in the left atrium, most often attached to the interatrial septum 3 . Approximately two‐thirds of myxomas are solid, round, or polyploid masses, often pedunculated, with a smooth and glistening surface while the remaining one‐third are soft masses, with friable papillary projections which may result in embolization 4 .…”

Mini Right Anterior Thoracotomy Approach versus Sternotomy for Resection of Intracardiac Myxoma

“…In case a defect was created in the site of tumor resection, it should be closed directly or patched. 8 Median sternotomy is common for myxoma approach because of the advantages of excellent visibility and convenient cannulation. The minimal invasive approach has been emerged into many areas of cardiac surgery.…”

Case report: left atrial Myxoma causing elevated C-reactive protein, fatigue and fever, with literature review

“…As described, myxoma is operated on by open heart surgery under cardiopulmonary bypass. The usual approach is via incision in the left atrium, posterior to interatrial groove to visualize the tumor [9]. However, given the large size of the myxoma and restricted access to the left atrium, decision was made to approach via right atriotomy.…”

“…A bi-atrial approach can be used if the base of the myxoma is sessile or papillary. Controversy exists as some argue that radical resection with excision of a full-thickness portion of the septum has no benefit over conservative excision, particularly with sporadic myxoma [9]. Research may be helpful in characterizing radical versus conservative septal excision.…”

“…The authors did not specify the time duration prior to elective surgery [5]. As shown, there is no literature that directly studies the effect of surgical timing on patient prognosis, however, the general consensus is that prompt surgical excision must be performed after diagnosis because of the high risk of valvular obstruction or systemic embolization [8,9,17]. Given this variability in time to surgical intervention, more studies may contribute to optimize the presurgical management of patients diagnosed with an intracardiac mass in terms of decision to anticoagulate and management of the risks of valvular obstruction and systemic embolization.…”