Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study

Abstract

Background: Cardiac myxoma (CM) is the most frequent, cardiac benign tumor and is associated with enhanced risk for cerebrovascular events (CVE). Although surgical CM excision is the only curative treatment to prevent CVE recurrence, in recent reports conservative treatment with antiplatelet or anticoagulant agents in high-risk patients with CM-related CVE has been discussed.Methods: Case records at the University Hospital of Tübingen between 2005 and 2017 were screened to identify patients with CM-related CVE. Clinical features, brain and cardiac imaging findings, histological reports, applied treatments and long-term neurological outcomes were assessed.Results: 52 patients with CM were identified and among them, 13 patients with transient ischemic attack, ischemic stroke or retinal ischemia were included to the (to our knowledge) largest reported retrospective study of CM-related CVE. In all identified patients, CVE was the first manifestation of CM; 61% suffered ischemic stroke, 23% transient ischemic attack and 15% retinal ischemia. In 46% of the patients, CVE occurred under antiplatelet or anticoagulation treatment, while 23% of the patients developed recurrent CVE under bridging-antithrombotic-therapy prior to CM surgical excision. Prolonged time interval between CVE and CM-surgery was significantly associated with CVE recurrence (p = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation.Discussion: Our results suggest that antiplatelet or anticoagulation treatment is no alternative to cardiac surgery in patients presenting with CM-related CVE. We found significantly prolonged time-intervals between CVE and CM surgery in patients with recurrent CVE. Therefore, we suggest that the waiting- or bridging-interval with antithrombotic therapy until curative CM excision should be kept as short as possible. Based on our data and review of the literature, we suggest that in patients with CM-related CVE, i.v. thrombolysis and/or endovascular interventions may present safe and efficacious acute treatments.

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

“…1 Neuroimaging studies have demonstrated that ischemic infarction events are the most frequent neurological findings (76.0-88.8%) in patients harboring left atrial myxomas with neurological manifestations. 6,16 In contrast, the exact prevalence of late neurological complications in these patients is unknown because long-term studies evaluating the likelihood of delayed neurological complications have not been conducted. The largest single-center study, by Brinjikji et al, in 47 patients treated for left atrial myxoma, reported that intracranial aneurysm and extravascular "metastasis" represented infrequent neuroimaging findings during the follow up of these patients (observed in 14.9% and 4.3% of cases, respectively).…”

Unilateral Cardioembolic Stroke in a Patient With Aortic Arch Anomaly

“…Our patient had a CM, which was diagnosed during this hospitalization and confirmed after the surgery. CMs occur most commonly in the fourth to seventh decades [10]. Although they are the most common benign primary heart tumors, they are quite rare.…”

Left Atrium Myxoma Revealed by an Ischemic Stroke: About a Case

“…While waiting for a mass resection surgery in our patient, we initiated an anticoagulant treatment with the antivitamin K. This choice was guided in this context of stroke by the fact that the mass caused an obstacle filling of the ventricle thus promoting the thrombus development. When the time for surgery is long, anticoagulant therapy may be proposed but only has impact on thromboembolic migrations and does not prevent tumor embolism [10].…”