Cardiac Myxoma

Ten patients with cardiac myxoma were reviewed. They ranged from 23 months to 60 years old. Echocardiography was the most helpful noninvasive diagnostic technique. The tumor was demonstrated by angiocardiography, left atrial myxomas frequently migrating to the left ventricle in diastole. Hemodynamically, left atrial myxomas were associated with moderately severe pulmonary hypertension and simulated mitral stenosis or insufficiency and right atrial myxomas, with right atrial hypertension. There were 7 myxomas in the left atrium, 2 in the right atrium, and 1 in the right ventricle.Eight patients underwent open-heart operation with removal of the myxoma, 1 had concomitant tricuspid valve replacement, and 1 had biopsy of the right ventricle only. The other patient was a Jehovah's Witness and refused operation. One patient died of cardiac arrest intraoperatively, and another died of a bilateral cerebral infarct. One patient had recurrence requiring reoperation. Postoperative hemodynamic and clinical improvement was more striking in patients with a left atrial myxoma presumably due to a normal mitral valve in contradistinction to the tricuspid valve.     

Diagnosis and treatment of 52 cases of cardiac myxoma

43 patients with cardiac myxoma had undergone surgical removal of the tumors under CPB 38 tumors were located in the left atrium, 5 in right atrium, and 1 in right ventricle respectively. The sites of attachment of the tumor stalk observed during operation were as follows: 34 left atrial myxomas were attached to the interatrial septum and 4 left atrial myxomas to the atrial wall. 5 right atrial myxomas were attached to the interatrial septum and 1 right ventricular myxoma to the ventricular wall. 1 patient with a right ventricular myxoma which had been removed one year ago appeared new one in the left atrium and the tumor was cut too. The diagnosis of cardiac myxoma was confirmed by 2D-echo-cardiography in all of our cases. Mitral valve replacement was done in 1 patient in this series. There was one death postoperatively. Besides these 43 cases, there were 9 patients who had not been operated upon, because of refusal of operation in 5, sudden death from cardiac arrest before operation in 2, coma from cerebral thrombosis in 1, and serious pulmonary tuberculosis in another one respectively.     

Myxoma developing after open heart surgery: is radiofrequency ablation responsible for the formation of the tumor?

34-year-old male with history of recurrent atrial fibrillation (AF) and mitral stenosis, status post radiofrequency ablation (RFA) and prosthetic mitral valve replacement two years earlier was admitted with prosthetic valve thrombosis for redo mitral valve surgery. During the surgery, a 2 x 1.5 x 1 cm mass was identified on the interatrial septum, attached to the edge of tricuspid valve's septal leaflet by a stalk. The mass was excised and histological evaluation revealed myxoma. It is accepted that myxomas can develop after cardiac trauma. It is known that RFA for AF increases the risk of thrombus or endocarditis in the atrium. Herein, we report a myxoma case where we think the heat energy caused by RFA might have triggered the development of the tumor.     

Surgical treatment of 22 cardiac myxomas: A review.

Twenty-two cases of cardiac myxomas were reviewed. The patients were 8 men and 14 women ranging in age from 12 to 73 (mean: 50.8 +/- 16. 6) at operation. They suffered from dyspnea, palpitation, and cough, similar to mitral disease symptoms, and cerebral emboli in 6 patients (30%) with left atrial myxomas. Echocardiography, especially transesophageal, was useful in diagnosing cardiac tumors and location. In 20 cases, tumors were at the left atrium and at the right in 2. Left atrial myxomas were approached through a septal incision in 17 cases; a large circular incision of the biatrium was used in 3 patients with large tumors or mitral regurgitation. Left atrial myxomas were attached to the atrial septum in 17 cases, the posterior wall of the left atrium in 2, and near the posterior commissure of the mitral valve in 1. Right atrial myxomas were attached to the atrial septum in 1 and posterior wall beside the inferior vena cava in 1. Resected myxomas weighed from 10 to 90 (mean: 39.1 +/- 19.1) g. No correlation was seen between features such as neurologic symptoms, feeding artery on coronary angiography, or functional status and tumor weight. No recurrence was seen.     

Determinação da massa residual em ventrículo esquerdo por ecocardiografia transesofágica intraoperatória após ressecção de mixoma gigante e flutuante em átrio esquerdo

Atrial myxoma is a benign tumor of the heart that occurs primarily in the left atrium. Floating or large left atrial myxomas frequently cause functional mitral stenosis, may also affect mitral valve structure and flow, and lead to mitral regurgitation. Systemic embolization occurs in around 30% of cases either from tumor fragmentation or complete tumor detachment hence it should be removed as soon as it is detected. Intraoperative transesophageal echocardiography has a vital importance in the surgery. After resection of myxoma, intraoperative transesophageal echocardiography must be performed to rule out residual mass. The case here reported is of a 48‐year old female, who presented with giant and floating left atrial myxoma. Residue mass was detected with intraoperative transesophageal echocardiography in the left ventricle after the resection of myxoma. Subsequently, the residue mass was successfully removed. Complete resection must be required to prevent possible complications such as recurrence, embolization in atrial myxomas. Transesophageal echocardiography performed intraoperatively is vital importance to confirm that the myxoma is completely resected.     

A rare pathology on the anterior mitral valve leaflet

Cardiac myxomas are most common tumors encountered in the left atrium and the transesophageal echo (TEE) appearance of myxomas may mimic a thrombus. Left atrial thrombi are more common than myxomas especially in patients with ventricular dysfunction, atrial fibrillation, mitral valve disease and they are classically found in the left atrial appendage. The incidence of left atrial thrombi in the presence of sinus rhythm is detected in only 0.1 % patients, in more than 20,000 TEE exams conducted over an 11-year period. In this encounter, patient had multiple pedunculated thrombi arising from an isolated point source on the A2 segment of the mitral valve leaflet. There was no prior history of any organic heart disease. In addition, there was no evidence of stasis in the left atrium.     

Transesophageal echocardiographic diagnosis of multicentric left ventricular myxomas mimicking a left atrial tumor.

We report a case of multicentric left ventricular myxomas with prolapse of one myxoma into the left atrium during ventricular systole that mimicked a left atrial tumor. The transthoracic echocardiogram showed large masses in the region of the mitral valve leaflets consistent with vegetations or tumors. A computed tomographic scan of the chest demonstrated two distinct left atrial masses, one of which appeared to prolapse from the left atrium into the left ventricle. Intraoperative transesophageal echocardiography showed a large pedunculated mass moving between the two left-sided cardiac chambers with intermittent trapping of the mass in the left atrium. The mass was attached to the left ventricular posteromedial papillary muscle by a long stalk. Another adjacent large ventricular mass was also noted in the left ventricle. These findings were confirmed at operation, which also demonstrated a third small tumor arising from the atrial aspect of the posterior mitral leaflet.     

Left atrial sarcoma with the initial diagnosis of myxoma

Primary tumors of the heart are rare. The majority of these tumors are benign, with myxomas located in the left atrium being the most common form. Almost all malignant tumors are sarcomas and occur preferentially in the right side of the heart. The case of a 73-year-old woman who presented with symptoms of mitral valve stenosis is reported. Echocardiography revealed a left atrial mass that was interpreted as atrial myxoma. At the operation, the tumor which was lobulated and had a smooth surface was arising from posterior wall of left atrium extending into the mitral annulus. Wide surgical excision was possible with left atrial reconstruction and mitral valve replacement. Histological and immunohistochemical studies revealed malignant undifferentiated sarcoma extending to the surface of mitral valve. Postoperative metastatic work-up showed no evidence of dissemination. The patient survived the operation without adjuvant radiation and chemotherapy and has been symptom-free over 1 year. At present, 16 months following the operation, the patient is alive with no evidence of disease.     

Cardiac myxomas: 24 years of experience in 49 patients

Objectives: In this single-center study we reviewed our experience with a significant number of cardiac myxoma cases occurring over the past two decades. Patients and methods: Cardiac myxomas represented 86% of all surgically treated cardiac tumors at our center. Specifically, there were 49 consecutive patients, each with at least one myxoma. A detailed clinical, immunological, and echocardiographic long-term examination of 37 patients revealed one recurrent myxoma. Results: Most myxomas originated from the left atrium (87.7%), but also much less frequently from the mitral valve (6.1%), from the right atrium (4.1%), and from the left and right atria (2.0%). The myxomas produced a prolapse into the left ventricle in 40.8% of the patients, mitral stenosis in 10.2%, and threatened left ventricular outflow tract obstruction in 2.0%. Multiple myxomas were found in 20.4% of the patients. Cardiac signs appeared in 93.9% of the patients. Preoperative embolic events had occurred in 26.5%. Immunologic alterations were present in 87.5%. For resection, a bilateral atriotomy was used. An additional aortotomy was needed to expose one mitral valve myxoma. Postoperatively, 81.1% of the patients remained without cardiac symptoms. The early mortality rate was 2.0% and the late mortality rate was 6.1%. Long-term prognosis was excellent with an actuarial survival rate of 0.74. Specific immunologic alterations were found in 71.4% of the patients. The actuarial freedom from reoperation of the myxoma was 0.96. The rate of reoperations was low with 2.0% after 24 years. Conclusions: Myxomas were usually detected and operated on in symptomatic patients. A high index of suspicion seems important for early diagnosis. Immunologic findings may play an additional role in confirming the diagnosis and the recurrence of a myxoma. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Also, a familial genesis must be excluded in myxoma patients.     

Second recurrence of cardiac myxoma 7 years after the initial operation

We report a rare case of a 23-year-old woman in who recurrent multiple cardiac myxomas were resected first time 4 years after the initial operation and second time three years after the second operation. In February 2000, she was diagnosed with right ventricular myxoma. The initial cardiac tumor was successfully resected through a right atrium approach and the tricuspid valve was changed with a biological prosthesis; the patient has been followed-up by ultrasound echocardiography every 6-month after discharge. Four years after, the echocardiography revealed one masse in the left atrium, which was resected using a trans-septal approach. Due to malfunction of the tricuspid prosthesis, this was changed with a biological one. After another three years, the echocardiography revealed once again two masses, this time in the right atrium and left ventricle. The third surgery was performed and all 2 myxomas were successfully resected through a combined right atrial and left ventricle approach. One year after the third operation, she has been doing well without any sign of recurrence of myxoma. A long-term follow-up is mandatory in patients after the resection of a cardiac myxoma.     

Bile Duct Injury during Laparoscopic Cholecystectomy: Risk Factors,Mechanisms, Type,Severity and Immediate Detection

34-year-old male with history of recurrent atrial fibrillation (AF) and mitral stenosis, status post radio-frequency ablation (RFA) and prosthetic mitral valve replacement two years earlier was admitted with prosthetic valve thrombosis for redo mitral valve surgery. During the surgery, a 2 χ 1.5 χ 1 cm mass was identified on the interatrial septum, attached to the edge of tricuspid valve’s septal leaflet by a stalk. The mass was excised and histological evaluation revealed myxoma. It is accepted that myxomas can develop after cardiac trauma. It is known that RFA for AF increases the risk of thrombus or endocarditis in the atrium. Herein, we report a myxoma case where we think the heat energy caused by RFA might have triggered the development of the tumor.     

Familial atrial myxoma in three generations: case report

Familial myxomas constitute 7 % of the total myxoma population exhibiting Mendelian autosomal dominant inheritance. We present a rare case of autosomal dominant benign familial myxoma occurring in three generations of the family operated successfully at our institute. A 40-year-old female presented with chest pain and palpitation, was diagnosed with left atrial myxoma, and was operated in 1993. After 2 years of surgery, the patient developed recurrent myxoma, and excision was done in 1995. A 22-year-old son complained of dyspnoea and chest pain. On evaluation, 5.6?×?2.6 cm right atrial myxoma attached to the roof of the right atrium was found, and the patient underwent myxoma excision in 2007. A 3-year-old granddaughter suffered from right hemiplegia. Echocardiography revealed left atrial myxoma 3 cm?×?2 cm pedunculated lesion causing diastolic obstruction of mitral inflow. Operated patients in all three generations and other siblings have been genetically screened. On genetic evaluation, all diseased had autosomal dominant single-gene defect or microdeletion. Atrial myxomas presented at earlier age successively and in more aggressive form in these three generations.     

Left atrial myxoma with neovascularization presenting as a sick sinus syndrome

Myxoma is benign tumor of the heart. It is mostly located in the left atrium and revascularized by the left and right coronary artery in 30% to 40% of cases. Symptoms of these neovascularized cardiac myxomas are typically quite variable, from obstruction of mitral valve to coronary embolism resulting in acute myocardial infarction. In this case, left atrial myxoma that is revascularized by nodal branches of the right coronary artery presented as a sick sinus syndrome, which is rare in literature.     

Free-floating left atrial ball thrombus without mitral valve disease

Reports of left atrial ball thrombus without mitral valve disease are few. We experienced a case of free-floating left atrial ball thrombus that developed in a short period in a patient with atrial fibrillation and dilated left atrium but intact mitral valve. Surgical removal of the thrombus was performed. It was presumed that atrial fibrillation and enlarged left atrium were the contributory factors to thrombus development.     

Surgical treatment of cardiac myxomas

Information of 40 patients operated on for cardiac myxoma was reviewed. The age ranges were as follows: nine patients, 20 to 30 years; seven patients, 31 to 40 years; 10 patients, 41 to 50 years; and 11 patients, over 50 years. One patient each was 14 months, 14 years, and 16 years old. Left atrial myxoma was diagnosed in 31 patients, left ventricular myxoma in one, right atrial myxoma in five, and right ventricular myxoma in two. Multiple calcified right atrial and ventricular myxomas were detected in one patient. Detailed clinical characteristics and diagnostic methods are presented. The hospital mortality rate was 7.5%. At 15 years' follow-up practically all of the patients had good late results. There were no recurrent myxomas. Rare left ventricular myxomas and multiple calcified right atrial and ventricular myxomas involving a tricuspid valve are also presented.     

Floating ball thrombus in the left atrium with mitral stenosis

We report, a case of a floating ball thrombus in the left atrium with mitral stenosis in a 76-year-old woman. The patient had been followed-up at our hospital due to mitral valve stenosis for several years, and was recognized to have atrial fibrillation and a left atrial mural thrombus by echocardiography. She was admitted to our hospital for right cerebral infarction. Echocardiography showed a floating ball thrombus in the left atrium. After the treatment of cerebral infarction, she was referred to cardiac surgery, and a semi-urgent operation was performed. Removal of the ball thrombus and mitral valve replacement were performed simultaneously. The thrombus was single round, soft, relatively smooth surfaced, and about 30×30×30 mm in diameter. The postoperative course was uneventful. Left atrial ball thrombus appears to be uncommon. This is a rare case, in which it was documented that a pre-existing left atrial mural thrombus was thought to drop off spontaneously, to be a cerebral embolic source, and to develop into a ball thrombus in the left atrium.     

机器人系统行心房黏液瘤切除术40例

目的 总结机器人二尖瓣置换术的临床应用,以评估其安全性及有效性.方法 2008年6月至2011年4月,20例患者接受机器人二尖瓣置换术,男7例,女13例;年龄32～65岁,平均(44.7±9.8)岁.术前心功能Ⅰ～Ⅱ级16例,Ⅲ级4例.15例合并房颤.股动、静脉及右侧颈内静脉插管建立体外循环.右侧胸壁打直径为0.8cm的器械臂孔3个,直径为1.5～2.5cm工作孔1个,术者于三维成像系统下遥控微创器械完成二尖瓣置换.术中食管超声引导建立体外循环并评估手术效果.术后常规进行随访.结果 无手术死亡及术中术式转化.机器人二尖瓣置换平均体外循环(137.1±21.9)min,主动脉阻断(99.3±17.4)min.随访(12.1±6.6)个月,未见瓣周漏等并发症.结论 机器人系统可安全、有效地完成二尖瓣置换,术后近期效果良好.

Abstract：

Objective To determine the safety and efficacy of robotic mitral valvereplacement using da Vinci S system.Methods From August 2008 to April 2011, over 400 cases of robotic cardiac surgery have been completed in Chinese PLA general hospital, in which 20 patients with isolated mitral valve stenosis underwent robotic mitral replacement, including 7 male and 13 female patients with a mean age of (44.7 ±9.8) years (ranging from 32 to 65 years). 16 patients had a NYHA class Ⅰ～Ⅱ heart function and 4 patients were NYHA class Ⅲ. Fifteen patients were concomitant with atiral fibrillation. Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion. Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection. The transesophageal echocardiography was used intraoperatively to estimate the surgical results. Results All patients had successful valve replacement including mechanical and tissue valve replacement. There was no conversion to a median sternotomy. The mean cardiopulmonary bypass and arrested heart time were(137.1 ±21.9) minutes and (99.3 ±17.4) minutes. Echocardiographic follow-up in all patients revealed no complications. Conclusion Robotic mitral valve replacement is safe and efficacious in the patients with isolated mitral valve disease.     

Multiple cardiac myxomas with multiple recurrences: unusual presentation of a "benign" tumor

A 20-year-old woman with a two-week history of palpitations and constitutional symptoms was found to have right atrial and left ventricular myxomas. The myxomas were excised, but the patient had two recurrences of the tumor in the left atrium four and a half years after the initial presentation. The recurrent myxoma was locally aggressive, and removal required excision of the aortic valve. This patient demonstrates the need for careful follow-up for recurrences of myxoma.     

Free-floating left atrial ball thrombus without mitral valve disease

Reports of left atrial ball thrombus without mitral valve disease are few. We experienced a case of free-floating left atrial ball thrombus that developed in a short period in a patient with atrial fibrillation and dilated left atrium but intact mitral valve. Surgical removal of the thrombus was performed. It was presumed that atrial fibrillation and enlarged left atrium were the contributory factors to thrombus development. (Jpn J Thorac Cardiovasc Surg 2005;53:52–54)     

Free floating ball thrombus of left atrium developing late after closed mitral commissurotomy - a case report

Left atrial ball thrombus is very rare entity and it is even rare to find a large free floating ball thrombus of left atrium in a post-operative patient. Thrombus of left atrium usually occurs in atrial fibrillation or in mitral valve stenosis. Here we are presenting a case of large ball thrombus of left atrium in a patient who underwent closed mitral commissurotomy 21 years back. A 50 years old female patient was admitted with history of breathlessness, palpitation and cough of one month duration. She was doing well after mitral valve commissurotomy. Her pre-operative trans-thoracic echocardiography showed a left atrial thrombus and severe mitral stenosis with valvular area of 0.7 cm² and atrial fibrillation. Per-operative trans-oesophageal echocardiography showed a large free floating ball thrombus of left atrium. She underwent removal of left atrial thrombus and mitral valve replacement using Sorin Bicarbon valve.