Risk Factors for Embolism in Cardiac Myxoma: A Retrospective Analysis

Abstract

BackgroundMyxomas are the most common primary heart tumors and are closely associated with embolic events. Cardiac myxomas typically arise from the interatrial septum at the border of the fossa ovalis in the left atrium. Any other location is considered atypical. Embolism, one of the complications of myxoma, is associated with high morbidity and mortality. The aim of this study was to investigate the risk factors for embolism in patients with cardiac myxoma.Material/MethodsIn this retrospective study, a cohort of 162 patients with cardiac myxomas was surgically treated between January 1998 and June 2014 at 3 cardiac centers in China. Preoperative data, including platelet count, sex, age, and the tumor (size, location, surface, and attachment), were compared between embolic and non-embolic groups of patients.ResultsNo significant differences in vascular risk factors were seen between the 2 groups. However, the percentage of higher platelet count (>300×109/L) and mean platelet volume in the embolic group were significantly higher than in the non-embolic group (P=0.0356, and 0.0113, respectively). Irregular surface and atypical location of the myxomas were also independently associated with increased risk of embolic complications.ConclusionsTumor location, macroscopic appearance, mean platelet volume, and high platelet count are strong risk factors for embolic events in patients with cardiac myxomas.

Atrial myxoma presenting as infective endocarditis

“…6 Complications can involve mechanical complications such as valvular obstruction, and embolisation has been reported in 30%-50% of patients. 7 By far the most common embolic complication is stroke, which accounts for over 80% of embolic phenomenon. 8 In contrast, metastatic involvement of the myocardium through haematogenous spread, direct invasion or tumour growth through the vena cava into the right atrium is relative common with an incidence of 8% in one large postmortem study of patients who died from cancer, with a particularly high frequency of myocardial involvement observed in squamous cell carcinoma of the lung (62%), urinary tract tumours (60%) and melanoma (45%).…”

Letter by Barik Regarding Article, “Now You See It, Now You Don’t?”

“…Recently, it was reported that tumor location, macroscopic appearance, mean platelet volume, and high platelet count are strong risk factors for embolic events in patients with cardiac myxomas. 5 Although most published series report that immediate surgery is necessary to avoid embolism, the authors planned surgical resection for the following week. What is the meaning of the following week?…”

Current challenges in the diagnosis and treatment of cardiac myxoma

“…A genetic to 2.5% of patients, in the left ventricle in 0.7% to 3.6% of patients, and in a heart valve (aortic, mitral) in fewer than 1% of patients. 1,4,9,11,13,19,20,24 Most studies reported that CM was identified in the left atrium in about 72% to 92% patients. 2,5,15 The fossa ovalis in the interatrial septum was the most common site to which CM, with or without a broad base, was attached.…”

“…13,21 Epidemiology Cardiac myxoma is a rare benign cardiac tumor, and its incidence is observed in approximately 0.5-1 cases per 1 million people per year. 1,4,11,24 The condition may develop in all ages, more frequently in women than in men. The demographic characteristics of patients included in this review are listed in TABLE 2.…”

“…1,4,7,10,20 However, approximately 3.2% to 46.4% of patients with CM are asymptomatic. 3,5,11,19,20 The clinical manifestations of patients included in this review are shown in A pedunculated tumor attached to the interatrial septum is the most frequent characteristic of atrial CM (FIGURE 4). A smooth tumor, which does not affect the adjacent structures, is also indicative of CM (FIGURE 5).…”