Complex Considerations and Anesthetic Management in Patient With Multiple Intracardiac Myxomas

Melnyk, Vladyslav; Hackett, Patrick J.; Subramaniam, Kathirvel; Badhwar, Vinay; Esper, Stephen A.

doi:10.1053/j.jvca.2016.09.036

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…Post-CPB TEE would provide an assessment of valve and cardiac function following resection. Like many other studies ( 1 , 7 , 31 , 32 ), we consider intraoperative TEE to be an indispensable instrument in the anesthesia management of cardiac myxoma resection.…”

Section: Discussionmentioning

confidence: 89%

“…Induction of general anesthesia in patients with myxomas should be performed cautiously with the following goals: constant monitoring of systemic blood pressure, adequate IV fluids, and judicious use of vasoactive medications to prevent a fall in systemic vascular resistance ( 7 ). There were three main treatments to avoid hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

“…However, the current literature contains only sparse recommendations for anesthetic management ( 5 , 7 ). Therefore, the anesthetic management needs to be clarified for patients undergoing myxoma resection, especially the prevention of hemodynamic instability after induction of general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic management of patients undergoing cardiac myxoma resection: a single-center retrospective analysis

Qi¹,

Yu²,

Yang³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundMyxomas are the most common primary cardiac tumors. Intracardiac myxomas, although benign, could cause serious consequences such as tricuspid or mitral valve obstruction, hemodynamic collapse, and acute heart failure, which pose challenges during anesthetic management. The current study was designed to summarize the anesthetic management of patients undergoing cardiac myxoma resection.MethodsThis study was performed retrospectively from the perioperative period of patients who underwent myxoma resection. Patients were divided into two groups according to whether the myxoma prolapsed into the ventricle (group O) or not (group N) to evaluate the impact of tricuspid or mitral valve with obstruction.Results110 patients, aged 17–78 years, undergoing cardiac myxoma resection between January 2019 and December 2021 were collected, and their perioperative characteristics were recorded. In the preoperative evaluation, common clinical symptoms included dyspnea and palpitation, whereas embolic events occurred in 8 patients, including 5 (4.5%) cerebral thromboembolic events, 2 (1.8%) femoral artery, and 1 (0.9%) obstructive coronary artery. According to the echocardiography, left atrial myxoma was detected in 104 (94.5%) patients, the average dimension of myxoma was 4.03 cm ± 1.52 cm in the largest diameter, and 48 patients were divided into group O. During intraoperative anesthetic management, hemodynamic instability occurred in 38 (34.5%) patients after anesthesia induction. More patients in group O had hemodynamic instability (47.9% vs. 24.2%, p = 0.009) than in group N. The mean postoperative length of stay in the hospital was 10.64 ± 3.01 days, and most of the patients made an uneventful postoperative recovery.ConclusionsAnesthetic management for myxoma resection can be composed by assessing the myxoma, particularly the echocardiography evaluation and preventing cardiovascular instability. Typically, tricuspid or mitral valve with obstruction is a premier ingredient in anesthetic management.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic management of patients undergoing cardiac myxoma resection: a single-center retrospective analysis

Qi¹,

Yu²,

Yang³

et al. 2023

Front. Cardiovasc. Med.

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“…The treatment is surgical excision and key aims of anesthesia care include constant monitoring of systemic blood pressure, adequate IV fluids, and judicious use of vasoactive medications to prevent a fall in systemic vascular resistance. 3 It is recommended to titrate the dose of propofol and fentanyl to obtain a proper anesthetic plane prior to endotracheal intubation, given the increased risk of mitral valve obstruction, use norepinephrine infusion 0.05 to 1 mcg • kg -1 • min -1 to maintain adequate myocardial perfusion and milrinone 0.3 to 0.5 mcg • kg -1 • min -1 if the patient has ventricular dysfunction.…”

Section: Images In Anesthesiologymentioning

confidence: 99%

Giant Left Atrial Myxoma Obstructing Mitral Valve Bloodflow

2019

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“…CARNEY COMPLEX (CNC) is a familial multiple endocrine neoplasia syndrome that potentially poses several anesthetic challenges as highlighted by Melynk et al 1,2 Initially reported in a group of 40 patients by J. Aiden Carney in 1985, this complex presents in patients with cardiac, endocrine, cutaneous, and neural tumors. 3 With the number of total recorded cases on the scale of about 500, CNC is extremely rare.…”

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confidence: 99%