Thirteen years follow-up of heart myxoma operated patients: what is the appropriate surgical technique?

Abstract

Background: Cardiac myxoma is a benign neoplasm that represents the most prevalent primary tumor of the heart. If not treated with the right surgical technique recurrence occurs. Aim of our study is to present our surgical approach and the histology of the tumors resected.

Methods: All patients, except for one, underwent extracorporeal circulation and mild hypothermia, right atrial or both atrial incision and excision of the fossa ovalis, followed by prosthetic patch suturing. All specimens were submitted for microscopic evaluation (haematoxylin-eosin). We contacted personally each patient and asked them to complete a standardized questionnaire, concerning their peri-operative characteristics.

Results: Six cases were "active" myxomas, 3 were "mildly active" and 3 were "inactive". "Normal differentiation" was seen in 6, "medium" in 1 and "poor" in 5 cases. In our series there were no recurrences recorded during the follow-up period.

Conclusions: The ideal approach, according to our experience is right atrial or both atrial incision as described by Shumacker and King, with excision of the fossa ovalis and the surrounding tissues and closure with a pericardial patch. Such a technique provides an excellent long-term survival in these patients.

Keywords: Surgery of myxomas; atrial myxoma; cardiac surgery.

Figure 1

Incision line from pulmonary vein to the free wall of atrium.

Figure 2

Incision line to the interatrial septum.

Figure 3

Final view of the approach to both atria.

Figure 4

Final view of the repaired atria.

Figure 5

Surface of the excised myxomas, covered by a single layer of flattened endothelial-like cells. (A) Smooth surface, (haematoxylin-eosin ×100); (B) Villous surface with multiple, friable villous extensions, (haematoxylin-eosin ×100).

Figure 6

Histologic characteristics of myxomas. (A) Active myxoma with normal differentiation. Increased cellularity of myxoma cells, which form rudimentary vascular structures, (Haematoxylin-eosin ×200); (B) Mildly active myxoma with medium differentiation—Variable cellularity of myxoma cells that form vascular structures, (Haematoxylin-eosin ×200); (C) Inactive myxoma with normal differentiation—Low cellularity of myxoma cells, which form rudimentary vascular structures, (Haematoxylin-eosin ×200); (D) Inactive myxoma with poor differentiation—Low cellularity of myxoma cells, dispersed or lepodic, which form short chains, (Haematoxylin-eosin ×200).