Right Atrial Trans-Septal Approach for Left Atrial Myxomas—Nine-Year Experience

Lad, Vidyadhur Shashikant; Jain, Jinendra; Agarwala, Sanjiv S.; Sinha, Vijoy Kumar; Khandekar, JV; Agrawal, Nandkishore; Khandeparkar, J.M.S.; Patwardhan, Anil

doi:10.1016/j.hlc.2005.06.008

Cited by 13 publications

(11 citation statements)

References 30 publications

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“…Therefore, it is important to choose the appropriate surgical approach to the myxomas. The surgical approach to the myxomas should allow minimal manipulation of the tumor, provide adequate exposure for its complete resection, enable inspection of all four cardiac chambers, minimize recurrence, and be safe and effective [32,33] .…”

Section: Discussionmentioning

confidence: 99%

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Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

Yüksel¹,

Saba²,

Velioğlu³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveWe aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery.MethodsWe retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections.ResultsForty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up.ConclusionAlthough myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.

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Section: Discussionmentioning

confidence: 99%

“…In several large case series, the early mortality rates have been 1-5% [7,9-11,33,44,45] . Our results were comparable with those reported in the literature; the early mortality rate was 2% in our series.…”

Section: Discussionmentioning

confidence: 99%

Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

Yüksel¹,

Saba²,

Velioğlu³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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“…As in most series, dyspnea and palpitation were the most common presentations in our cases. 9 High erythrocyte sedimentation rate was the most common laboratory finding with a mean of 39 ± 34.…”

Section: Commentmentioning

confidence: 99%

Primary Cardiac Myxomas: Clinical Experience and Surgical Results in 67 Patients

Taşoğlu

Tütün

Lafçı

et al. 2009

Journal of Cardiac Surgery

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“…The bi-atriotomy approach (LA incision + RA incision ± TS) to cardiac myxomas was popularized by Cooley in 1973 [26] its advantages are excellent exposure and localization of the resection margin by direct visualization of the tumor pedicle, minimal manipulation of the tumor and it allows examination of all cardiac chambers and easy repair the septal defect [23]. On the other hand, it was criticized for being responsible for a high incidence of arrhythmias and conduction disturbances after resection of LA myxomas [28]. In our experience, bi-atrial approach (LA incision + RA incision) was used only in three cases (17.6%) with huge left atrial myxoma attached to the septum not amenable for safe resection using an isolated left atrial approach.…”

Section: Discussionmentioning

confidence: 99%

“…The Right atrial trans-septal approach facilitates wide excision of the tumor without mandating direct handling [27], permits adequate mitral exposure, allows inspection of heart chambers for concomitant tumors [28], and it allows easy repair of a single incision on the right atrium; additionally, it was associated with a low recurrence rate [1]. In our series, the right atrial trans-septal approach was used successfully in 13 out of 17 cases (76.4%) of left atrial myxoma.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Myxomas: A single center experience and ten-years follow up

Mohamed

Ghaffar

Abdelaal

et al. 2019

Egypt. Cardiothoracic. Surg.

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Background: Cardiac myxoma is a benign tumor that carries the risk of embolization and obstruction of the blood flow. The ideal surgical approach is still debatable. We present our experience in the surgical treatment of cardiac myxomas and its ideal surgical approach. Methods: We retrospectively analyzed the data for all patients who underwent surgical excision of cardiac myxoma at our institution over 11 years starting from January 2006 to December 2016. Descriptive statistics were used to present preoperative, operative and postoperative data and Kaplan Meier curve to plot long-term survival. Results: Twenty-one patients had surgical excision of a primary, single and sporadic cardiac myxoma. Thirteen patients (62 %) were females, and the mean age at operation was 55.2 years (range: 28 -71 years). The location of myxomas was in the left atrium in 17 patients (81%) and right atrium in 4 patients (19 %). Dyspnea was the main presenting symptom (71.4%) followed by constitutional symptoms (28%), palpitations (23.8%), syncope (14.2%) and stroke (14.2%). A right atrial trans-septal incision was used in 76.5% of left atrial myxoma cases. Five patients had concomitant operative procedures (coronary artery bypass grafting (n=2), tricuspid valve repair (n=1), mitral valve replacement (n=1) and bullectomy (n=1)). Postoperative complications were reported in six patients (28.6%) (supraventricular arrhythmia (n=2), temporary conduction deficit (n=2), pulmonary atelectasis (n=1), and postoperative bleeding (n=1)). Early postoperative mortality occurred in one patient (4.76 %), and there were no late deaths related to myxoma. Conclusion: Surgical treatment of cardiac myxoma is safe with low morbidity and mortality. The right atrial trans-septal incision is the recommended surgical approach.

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Right Atrial Trans-Septal Approach for Left Atrial Myxomas—Nine-Year Experience

Cited by 13 publications

References 30 publications

Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

Primary Cardiac Myxomas: Clinical Experience and Surgical Results in 67 Patients

Cardiac Myxomas: A single center experience and ten-years follow up

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