Cardiac myxoma: single tertiary centre experience

Abstract

Background: Although cardiac myxoma (CM) are rare and benign, they can cause life-threatening complications, such as hemodynamic disturbances or embolization. Surgical excision of the tumour is the treatment of choice. The aim of the study was to evaluate the epidemiological characteristics, clinical presentation, imaging findings, and outcomes of surgical treatment of patients with CM treated in the largest tertiary care centre in Slovenia.

Patients and methods: We retrospectively analysed the medical records of all patients referred to our institution between January 2005 and December 2020 and identified 39 consecutive adult patients with pathologically confirmed CM.

Results: The average annual incidence of CM in the study was 3 per 2 million population per year. Patients were more often female (n = 25, 64%). The mean age at diagnosis was 63.1 ± 13.6 years. Dyspnoea was the most common presenting symptom (31%). CM was an incidental finding in 11 patients (28%). Seven patients presented with thromboembolic event (18%). Transthoracic echocardiography (TTE) was performed in all patients, however additional imaging was required in 22 patients (56%). All patients in our series were successfully treated surgically without in-hospital mortality. During the follow-up period (6 months to 16 years) three patients (8%) died, and all deaths were unrelated to CM. There was no recurrence of CM during the follow-up.

Conclusions: Our single-centre study confirms that CM is rare cardiac tumour with diverse clinical presentation. Our data shows data that CM might be more prevalent than considered before. Surgical resection of the tumour is safe with excellent short- and long-term outcomes.

Keywords: cardiac myxoma; cardiac tumours; echocardiography.

Figure 1

Distribution of patients diagnosed per year.

Figure 2

Transthoracic echocardiography, apical 4-chamber view. Cardiac mass in left atrium is attached to the interatrial septum in the region of the fossa ovalis (arrow). Histopathological characterization confirmed cardiac myxoma. LA = left atrium , LV = left ventricle; RA = right atrium; RV = right ventricle

Figure 3

Cardiac magnetic resonance, late gadolinium enhancement, 4-chamber view. Asterix – Large mass occupying the entire left atrium with heterogeneous pattern of enhancement, consistent with cardiac myxoma. LV = left ventricle; RA = right atrium; RV = right ventricle

Figure 4

Abundant myxoid stroma with clusters of myxoma cells forming cords and ring structures (HE 100x).

Figure 5

(A) Intraoperative view of myxoma protruding through fossa ovalis with its smaller part in the right atrium (arrow) and larger part in left atrium (asterisk). (B) The left atrial part of the myxoma.