Cardiac Myxomas: A Word of Caution Regarding Neuropsychological Disturbances

All articles of this category Objectives: Myxomas represent nearly 50% of all primary cardiac tumors. Approximately 95% of cardiac myxomas occur isolated - recurrent rate of sporadic cases is 5%. Left atrium is the most common origin of this generally polyploid and pedunculated tumor. Methods: During the retrospective 12-year period between June 2004 and June 2016 we evaluated 52 patients (mean age 61.7 ± 16.9 years; 63.5% female and 36.5% male) undergoing resection of cardiac myxoma. Most patients were asymptomatic ( n = 29, 55.8%) and palpitations ( n = 14, 26.9%), dyspnea ( n = 9, 17.3%) were the most common symptoms. Clinical diagnosis was based on transthoracic and transesophageal echocardiography, additionally MRI as well as CT-scan. Results: The left atrium was the most common location ( n = 47, 90.4%), followed by the right atrium ( n = 4, 7.7%), left ventricle ( n = 1, 1.9%) and as well right ventricle ( n = 1, 1.9%). Bypass time was 62.7 ± 25.1 minute and clamp time 36.9 ± 22.4 minute. The mean size of tumor was 3.05 ± 1.77 cm × 13.52 ± 15.51 cm - independent to symptoms and patient age. Postoperative complications were: stroke ( n = 6, 11.5%), TIA ( n = 5, 9.6%) and need for pacemaker implantation ( n = 2, 3.8%). There was no perioperative, in-hospital or 6 months mortality. Two patients had a redo resection cause of recurrence in left atrium - one patient (female, 57 years) got a myxoma resection in 1999 and the other (female, 79 years) in 2004. Thus tumor recurrence rate was 3.8%. Conclusion: When detailed neurological investigation is applied 21.15% of the patients developed neurological symptoms, despite intraoperative echocardiography and careful planning of the operation. As the incidence of neurological events increases with myxoma size and early operation is recommended to keep the neurological risk as low as possible. Furthermore myxomas require complete surgical resection including the pedicle approach - Follow-up with echocardiography is essential to detect recurrence.