CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 28 AFRICA including clinical features, diagnostic methods, surgical procedures and postoperative follow up of 34 patients who were operated on for intracardiac myxomas. Methods Between January 2006 and June 2022, 34 patients who were diagnosed with cardiac myxoma and underwent surgery with cardiopulmonary bypass (CPB) in Private Kocaeli Acıbadem Hospital and Health Sciences University Derince Training and Research Hospital Cardiovascular Surgery Clinics were included in the study. The operations were performed in two different centres but by the same surgical team. The patients included in the study were divided into two groups: a symptomatic group 1 (n = 19) and an asymptomatic group 2 (n = 15). The demographic and clinical data of the patients were obtained using the software system of the hospital for records and archives. We investigated the patient files, epicrisis, operation notes and laboratory results. The demographic and clinical characteristics of the patients, New York Heart Association (NYHA) class and presentation of cardiac tumours, complete blood counts and biochemical parameters studied routinely before and after surgery, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded. Operation information, duration of CPB and aortic cross-clamping, postoperative hours of ventilation, mediastinal drainage, postoperative complications, histopathological findings of the tumour, amount of blood products used and length of stay in the intensive care unit and hospital were also recorded. Transthoracic echocardiography (TTE) was performed on all patients by the cardiology clinic to diagnose myxoma and to evaluate their heart structures and chambers, and they were referred to our clinic for surgery. In doubtful cases, the diagnosis of myxoma was clarified by performing transoesophageal echocardiography (TEE) by the cardiology clinic. A TEE image of a patient’s right atrial myxoma with tricuspid valve stenosis is shown in Fig. 1. Coronary angiography was performed on all patients included in the study to determine the blood supply of the myxoma and to exclude atherosclerotic coronary artery disease and coronary embolism. CT and cardiac MRI were also used in some of the patients as required. CT or cardiac MRI was performed, especially in patients in whom the place of attachment of the myxoma could not be clearly seen on echocardiographic imaging and in patients who needed a differential diagnosis of thrombus. The date of surgery for all patients was decided according to the clinical condition of the patient. All patients were routinely checked with TTE prior to discharge, and were followed up on an out-patient basis at regular intervals every year thereafter. This study complied with the Declaration of Helsinki and was carried out following approval of the Ethics Committee for Clinical Trials of Kocaeli Derince Training and Research Hospital of Health Sciences University (ethics committee approval number: 2022/104). In order to avoid embolic complications or sudden death, a surgical decision was made in all patients after the diagnosis of atrial myxoma. All patients were operated on with a median sternotomy under general anaesthesia. Standard CPB was established with aortic and bicaval venous cannulations, and systemic heparin (300 IU/kg) was introduced with maintenance of activated clotting time > 450 seconds. Hyperkalaemic cold blood cardioplegia was applied for cardiac arrest. Surgery was performed under moderate hypothermia (28–30ºC). CPB flow was maintained at 2.2–2.5 l/min/m2, Fig. 1. Right atrial myxoma image on TEE. A B Tricuspid valve Tricuspid valve
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