CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
310
AFRICA
Diagnosis and follow up of patients with primary cardiac
tumours: a single-centre experience of myxomas
S MANDUZ, N KATRANCIOGLU, O KARAHAN, O YUCEL, MB YILMAZ
Abstract
Objective:
In this study, 12 patients who were diagnosed
as having cardiac tumours and were operated on in the
Department of Cardiovascular Surgery following referral
from the Department of Cardiology were enrolled between
January 1995 and October 2007.
Methods:
The symptoms, clinical findings, diagnostic meth-
ods, localisation of masses and surgical applications were
recorded retrospectively.
Results:
There were 10 female (83%) and two (17%) male
patients; their ages ranged from 35 to 70 years (mean 68.7
years). Twelve patients were diagnosed with myxomas, nine
of which were located within the left atrium and three in
the right atrium. The most common symptoms at clinical
presentation were those associated with heart failure or
embolisation. Diagnosis of the tumours was made by echo-
cardiography in all patients. The masses were completely
resected in eight patients and the interatrial septae were
partially excised with mass resection in two patients. The
defect was reconstructed with a pericardial patch in one of
the patients, and primarily reconstructed in the other. We
carried out debridement with mass resection in another case.
Femoro–popliteal aorto–iliac thrombo-endarterectomy was
performed with mass resection in a further case.
Conclusion:
Atrial myxomas are the most common primary
cardiac tumours. They can cause valvular or inflow–outflow
tract obstruction, thrombo-embolism, arrhythmias, or peri-
cardial disorders. Most atrial myxomas are benign but due
to non-specific symptoms, early diagnosis may be a challenge
and they must be removed by surgical resection. Diagnosis
and follow up with the collaboration of cardiology and
cardiovascular surgery departments is important for meticu-
lous care of these patients.
Keywords:
myxoma, diagnosis, surgery
Submitted 11/11/09, accepted 31/8/10
Cardiovasc J Afr
2011;
22
: 310–312
DOI: 10.5830/CVJA-2010-073
Primary cardiac tumours are rare. Their prevalence ranges from
0.0017 to 0.28% in various autopsy series, and they are up to 20
times less frequent than are secondary tumours of the heart.
1,2
The prevalence of primary cardiac tumours other than benign
myxomas is even lower.
1-3
In 1954, Clarence Crafoord removed
an intra-atrial myxoma for the first time. Echocardiography has
enabled better visualisation of the cardiac structures and accurate
diagnosis.
4
Approximately 75% of sporadic myxomas occur in females.
Myxomas have been reported in patients aged three to 83 years.
3-5
They are rarely seen in children, accounting for only nine to 15%
of all cardiac tumours from birth to adolescence.
5
Early diagnosis and surgical removal of the tumour with
decreased mortality and morbidity is related to the symptoms
produced, such as tumour embolism, heart failure, mechanical
valvular obstruction, and various constitutional symptoms.
6
We
retrospectively reviewed our case series with particular attention
to myxomas.
Methods
In this study, 12 patients who suffered from myxomas were
diagnosed and operated on in the Departments of Cardiology and
Cardiovascular Surgery, respectively, between January 1995 and
October 2007. Symptoms, clinical findings, diagnostic methods,
localisation of the mass and surgical application were evaluated
retrospectively.
Echocardiographic examinations were performed by an expe-
rienced echocardiographer using available ultrasound equipment
(GE-Vivid 4 with a 3.5 MHz transducer, Wisconsin, USA) at
baseline, and as required during follow up. Pre-operative coro-
nary angiography was performed in patients with known or
suspected coronary artery disease.
Results
There were 10 female (83%) and two (17%) male patients; their
ages ranged from 35 to 70 years (mean 68.7 years). All patients
were diagnosed as having myxomas on pathological verification.
Nine of these myxomas were in the left atrium and three were in
the right atrium. All myxomas were sporadic. The most common
symptoms at clinical presentation were those associated with
cardiac insufficiency or embolisation. There was haemoptysis in
one patient with bronchiectasis.
Diagnosis of the tumours was made by echocardiography
before surgery in all patients (Fig. 1). Computed tomography
and angiocardiography were also used in some of the patients as
required. The masses were completely resected in eight patients
and the interatrial septae were partially excised with mass resec-
tion in two patients (Fig. 2). The defect was reconstructed with
a pericardial patch in one patient and primarily reconstructed
in the other. We carried out debridement with mass resection in
another case. Femoro–popliteal aorto–iliac thrombo-endarterec-
tomy was performed with mass resection in a further case and the
embolectomy material was confirmed as a myxoma. Coronary
Department of Cardiovascular Surgery, Faculty of Medicine,
Cumhuriyet University, Sivas, Turkey
S MANDUZ, MD
N KATRANCIOGLU, MD
O KARAHAN, MD,
Department of Cardiology, Faculty of Medicine, Cumhuriyet
University, Sivas, Turkey
O YUCEL, MD
MB YILMAZ, MD
