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.     

A successful resection of recurrent right ventricular myxoma]

A successful surgical treatment of right ventricular myxoma of twenty-year-old male was presented, who healed already previous resection of left atrial myxoma two year and eight months prior to this operation. He has been followed up closely after the first resection of left atrial myxoma for the recurrence in the left atrium. Follow-up echocardiography demonstrated the development of myxoma in the free wall in the right ventricle. The resection for this myxoma was found to be relatively easy at the second operation. The tumor was removed with the stark, without any postoperative problem. According to the literature, this case seems to be the second Japanese case of surgical treatment of right ventricular myxoma following the removal of left atrial myxoma.     

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.     

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.     

Successful resection of the right atrial myxoma with excessive tumor vascularity in a elderly patient

A 72-year-old female underwent successful resection of a giant right atrial myxoma. The patient had slight cough with abnormal cardiac silhouette and elevated ESR. The diagnosis of right atrial myxoma was established by echocardiography and angiography. Venacavography revealed huge mass which occupied in the entire right atrium. This tumor was perfused by well developed feeding arteries arising from both right and circumflex coronary arteries, and showed rich tumor vascularity. This tumor was resected with the interatrial septum and the free wall of the right atrium which were attached with tumor. Interatrial septal defect was closed with a Teflon fabric patch and the defect of right atrial free wall was approximated by direct closure with Z-plasty. Postoperative course was uneventful. Pathological examination showed myxoma without invasion into the resected septum and atrial wall. It is important to prevent tumor embolization to the pulmonary artery or strangulation into the right ventricle during surgery on this type of huge right atrial myxoma.     

Familial cardiac myxoma: emphasis on unusual clinical manifestations.

This report describes familial cardiac myxoma involving parent and child. The familial occurrence of this condition, previously reported in four other families, underscores the necessity of screening all direct members of the family by echocardiography once the diagnosis of cardiac myxoma is made. Each patient presented with unusual clinical manifestations. The father, who had a right atrial myxoma associated with an atrial septal defect and mitral valve prolapse, presented with findings highly suggestive of paradoxical embolism. The daughter, who had an infected right ventricular myxoma, was initially treated for valvular subacute bacterial endocarditis before the diagnosis was made.     

Right ventricular myxoma in a 71-year-old female

Right ventricular myxoma in elderly is vey rare and this is the 36th case report of right ventricular myxoma in Japan. A healthy 71-year-old female with no symptoms or constitutional signs except heart murmur was hospitalized. Findings of transthoracic echocardiogram, CT scan, MRI and angiocardiogram demonstrated a mobile tumor in the right ventricular outflow tract. Transesophageal echocardiogram clearly revealed that the stalk was arising from the right ventricular free wall. Under cardiac arrest, right atriotomy was made and a gelatinous tumor (4.5 × 2 × 2 cm in size, 7.3 g in weight) was excised with 5 mm of surrounding endocardium and a few millimeters of underlying myocardium through the tricuspid valve. Histopathologically, the tumor was diagnosed as a myxoma. Her postoperative course was uneventful.     

Cardiac tumors in 19 years of private practice

Since 1966 the authors have encountered nine cardiac tumors: eight myxomas and one tumor initially thought to be a sarcoma but histologically a squamous carcinoma. Seven myxomas were left atrial and the other were right atrial in location. The carcinoma was predominantly located in the right ventricle. Eight of the nine patients were female; ages ranged from 32 to 85 years. Of the myxomas, five displayed fever and dyspnea, two congestive heart failure and one transient ischemic episodes. The patient with carcinoma was in right heart failure. All patients underwent cardiac catheterization as well as echocardiography when it became available. Five myxomas were correctly diagnosed preoperatively while three were thought to have mitral stenosis. The patient with carcinoma showed a large right ventricular filling defect and a picture of constriction. All myxoma patients underwent surgery--three via left thoracotomy and five via sternotomy. Seven patients survived; however, the patient with right atrial myxoma was explored via the left chest for mitral stenosis and the myxoma was not discovered. She died of a pulmonary embolism pathologically confirmed as myxoma. All survivors have been followed by yearly echocardiograms and are free of recurrence. The patient with carcinoma died before surgery could be performed. Autopsy revealed almost complete replacement of the right ventricle by tumor and constrictive pericarditis. The terminal event was pulmonary embolus of squamous carcinoma. Although cardiac tumors are a rare entity, a high incidence of suspicion plus modern diagnostic methods can yield the diagnosis and allow a curative operation.     

Familial cardiac myxoma with multiple and contralateral recurrence

This report described a familial recurrent cardiac myxoma involving mother and daughter. The mother, at 27 year of age, had developed recurrent multiple myxomas in both left and right atrium and right ventricle 4 years after surgical excision of left atrial myxoma. Excision was successful and remains well without signs of recurrence 9 years postoperatively. In an asymptomatic 13-year-old daughter, a recurrent left atrial myxoma was found 3 years after the excision of right atrial myxoma by echocardiographic follow-up at 6 month intervals. Excision of left atrial myxoma was performed and histology showed the essentially the same findings as primary myxoma without signs of malignancy. From an experience of this familial recurrent myxoma and a review of 38 cases of 17 familial cardiac myxoma, it is recommended that wide excision of tumor including surrounding tissues, thorough search for multiple heterotopic tumors at surgery, close postoperative echocardiographic follow-up for at least 5 years, and examination of skin and breast tumor, and endocrine disorder for "complex" myxoma.     

Successful excision of right ventricular myxoma

A 17-year-old woman with right ventricular myxoma is reported. The diagnosis was made by means of two-dimensional echocardiography. Under extracorporeal circulation, the tumor was successfully excised through a right atrial approach. Right ventricular myxoma is a rare disease but when the exact diagnosis has been established, urgent operation is mandatory because of the impending danger of sudden death from pulmonary embolism or obstruction of the outflow tract by the tumor.     

Tumorectomy with right thoracotomy for synchronous left atrial myxomas from Carney complex: report of a case

This report describes a case of synchronous left atrial myxomas from Carney complex resected through a right thoracotomy. The patient was a 30-year-old female that had previously been diagnosed with Carney complex following a genetic examination. Preoperative echocardiography showed a left atrial tumor, but intraoperative inspection revealed another tumor in the left atrium. Carney complex was first described in the 1980s and cardiac myxoma from Carney complex can occur in any cardiac chamber, presenting multiple times with postoperative recurrences, occurring at any age and without any predilection for gender, and is inherited in an autosomal-dominant manner. Treatment for cardiac myxoma from Carney complex is very important for patient mortality and morbidity and, despite the endocrine nature of the disorder, cardiologists and cardiac surgeons play an important role.     

Cardiac Sarcoma Originating from the Tricuspid Valve

Primary cardiac sarcomas are uncommon. We report an unusual presentation of a cardiac sarcoma that originated from the posterior leaflet of the tricuspid valve. This tumor, which provided a working diagnosis of tricuspid valve myxoma before and during surgery, should be considered in the differential diagnosis of right atrial and ventricular masses.     

Right Ventricular Myxoma: Review of the Literature and Report of Two Patients

The cases of 2 patients with right ventricular myxoma are reported, together with a review of the literature. In both patients the ultimate diagnosis was reached by means of angiocardiography, which revealed large filling defects in the right ventricle. In 1 patient, cardiac catheterization failed to record a transpulmonary gradient. Echocardiography, performed after hemodynamic investigation in both patients, revealed the usual pattern of abnormal echoes moving from the right ventricular cavity to the right outflow tract during the cardiac cycle.In both patients the tumor was successfully excised through a right atrial approach. This approach was preferred to the right ventriculotomy because it provides adequate surgical exposure, avoids undue trauma to the ventricular myocardium, and offers an easy way for inspection of the left heart.     

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.     

Sinoatrial nodal artery to right atrium fistula after myxoma excision

Acquired coronary artery to cardiac chamber fistulas are rare. Angiographically detectable neovascularization associated with a cardiac myxoma occurs frequently. These vessels are incorporated into the atrial suture line during surgical excision. We describe the case of a patient with a symptomatic right coronary artery to right atrial fistula that had occurred 4 years after left atrial myxoma resection. These large vessels should be considered for ligation during the myxoma resection.     

A case of biatrial multiple myxomas with glandular structure.

A 45-year-old male, who had been indicated by brain magnetic resonance imaging to have cerebral infarctions, was found by echocardiography to have a tumor in the left atrium. He had experienced several of the constitutional disturbances associated with myxoma. At the ages of 19 and 35 he had had two episodes associated with embolisms, and at the later one he was diagnosed as having multiple cerebral aneurysms. He received an urgent operation in which three left atrial tumors and one right atrial tumor were resected. Histologically, the tumors were myxomas, and the left atrial main tumor had glandular structure. In view of his clinical history, this patient seems to have had cardiac myxomas for a long period. The multiple growths that occurred in this case may be a good argument for allowing this condition to last for so long. To our knowledge, the present case was the first report of cardiac myxoma with glandular structure in Japan.     

Ossifying cardiac myxoma with neovascularity

We report a 64-year-old man with ossifying cardiac myxoma which radiographically demonstrated visible calcification. A lateral chest radiograph showed abnormal calcification in the cardiac shadow. Two-dimensional and transesophageal echocardiography revealed a heterogeneous mass with a hyperechoic lesion in the left artium. A coronary angiogram showed a neovascular formation extending from the coronary arteries to the tumor. The resected tumor was composed of round or spindle shaped cells with myxoid stroma, accompanied by extensive calcification and ossification containing fatty and hematopoietic marrow tissue. Although a left atrial calcified myxoma is less common than a right sided myxoma, and such radiographically detectable calcified tumors are rare, the presence of radiographic visualized calcification in the cardiac shadow should be ruled out for left as well as right atrial myxomas.     

Massive Right Atrial Myxoma Causing Right Ventricular Inflow Obstruction: An Unusual Presentation of Myxoma

Abstract We describe a case of a massive right atrial myxoma, causing right ventricular inflow obstruction. The tumor was detected by echocardiography and resected along with a section of the tricuspid septal leaflet, followed by primary repair, resulting in relief of her symptoms . (J Card Surg 2010;25:293‐295)     

Successful surgical treatment of a right atrial myxoma complicated by pulmonary embolism

We report on a rare case of a 65-year-old woman who was admitted with orthopnea (NYHA class IV) and a single syncopal episode. A transthoracic echocardiography examination showed a 7x6x6-cm mass located in the right atrium and perfusion lung scan showed embolization. Complete surgical removal of the right atrial myxoma and tumor embolectomy was successfully performed with deep hypothermia and circulatory arrest. Histologic investigations of the primary tumor as well as the emboly revealed benign myxoma. Six months clinical and echocardiographical follow-up showed a satisfactory exercise tolerance, a normal right atrium and a good ventricular function. Thirteen years later, the patient remains well and no recurrence could be observed.     

Contralateral recurrent myxoma of the heart.

Nineteen recurrences of a left atrial myxoma have been reported in 16 patients. This paper deals with the removal of a right ventricular myxoma three and one-half years following excision of a left atrial tumor. Because of the possibility of recurrence, postoperative follow-up of all patients with intracardiac myxomas is mandatory.