Clinical presentation of atrial myxomas does it differ in left or right sided tumor?

Abstract

Objective: This paper reports a 20 years' experience in the management of atrial myxomas at our institution. Apart from presenting our experience of their clinical presentation, surgical management, post-operative complication, and long-term follow-up we investigated any correlation between left and right sided tumor with their symptom of presentation.

Materials and methods: The data were retrospectively collected for patients between the period 1995 and 2015 from the hospital database. The follow-up was conducted by questionnaire received from the patients describing their current status.

Results: Fifty four consecutive patients underwent surgical resection for atrial myxomas. The mean age was 62 years (standard deviation [SD]: ±14 years) with a larger number of female (55.5%) patients. The most common location for the tumor was the left atrium (70.3%) with the atrial septum being the most common (63%) site of attachment. The tumors presented in a variety of ways, namely, as shortness of breath (37.03%), transient ischemic attack (24.07%), and chest pains (22.2%) being the more common modes of presentation. Left heart tumors presented 6 years earlier with more severe shortness of breath as compared to right-sided tumors. Post-operative atrial fibrillation occurred in 22.2% of patients. Concomitant surgical procedures were required in 26% of patient. The median length of post-operative hospital stay was 6 days (IQR: 5; 9). There were 2 (3.7%) in-hospital mortalities and 4 (7.4%) later deaths at 2, 3, 7, and 15 years, respectively. Long-term follow-up actuarial Kaplan-Meire survival for the whole group was 92.6 ± 3.6% at 20 years with a significant reduction in the severity of shortness of breath.

Conclusion: Cardiac myxoma is the most common form of the cardiac tumor with a slight female preponderance. Left-sided tumors present earlier than right-sided tumors with more severe shortness of breath. Excellent long-term results can be achieved with surgical intervention for cardiac myxomas, including any concomitant interventions. In particular, a sustained reduction in shortness of breath is observed.

Keywords: Tumor; cardiac; myxomas.

Figure 1

Computed tomography scan showing the myxoma in the left atrium

Figure 2

Transesophageal echocardiogram showing myxoma in the left atrium

Figure 3

(a and b) Gelatinous myxoma 37 (68.4%), (c) hard pedunculated myxoma 13 (24%), (d) large pseudo capsulated myxoma 2 (3.7%), (e) hemorrhagic myxoma 1 (1.85%), (f) multiloculated myxoma 1 (1.85%). This figure does not give number and percentage of different myxomas of the study