CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 29 mean perfusion pressure between 50 and 80 mmHg, and haematocrit level between 20 and 25%. In order to avoid embolic complications, including in patients requiring additional surgical procedures, the existing myxoma was completely removed first. Left or right atriotomy incisions with a trans-septal approach were used as the surgical approach for myxoma. The mass in the right or left atrium was completely resected. After the heart cavities were thoroughly checked for tumour residue, abundant irrigation of the atrium and ventricle with cold saline solution was performed after resection to prevent tumour recurrence and intra-operative embolisation. After these procedures, the left or right atriotomy was closed. In the presence of myxoma attached to the interatrial septum, the resected septum with the tumour was closed with a pericardial patch. Postoperatively, all patients were transferred intubated to the intensive care unit. They were extubated following the onset of spontaneous breathing and normalisation of orientation and co-operation if the haemodynamic and respiratory functions were appropriate. Patients who did not develop major complications in the postoperative period were followed up in the patient rooms of the service. Statistical analysis Characteristics of symptomatic and asymptomatic patients were compared using IBM SPSS software version 22.0 (SPSS Inc, Chicago, IL, USA). Among the data measured, those showing normal distribution are expressed as mean ± standard deviation and those not showing normal distribution are expressed as median (minimum–maximum). The numerical data are given as percentages. Among the data measured, the normality of distribution was evaluated by histogram or Kolmogorov–Smirnov test, and the homogeneity of distribution was evaluated by Levene’s test for equality of variance. In the analysis of continuous variables, the student’s t-test was used for those with normal distribution, and Mann–Whitney U-test for those without normal distribution. Pearson’s chi-squared test or Fisher’s exact test was used in the analysis of categorical data. For all tests, p < 0.05 was considered to be statistically significant. Results The demographic characteristics and clinical data of the patients are summarised in Table 1. There was no statistically significant difference between symptomatic and asymptomatic patients. In our study, 25 (73.5%) of the myxomas completely removed surgically were localised in the left atrium, while nine (26.5%) were in the right atrium. There were no myxomas in any other cardiac cavities. The pre-operative and early postoperative blood analysis and haematological parameters of the patients are summarised in Table 2. Pre-operative ESR levels were significantly different between the groups (p = 0.02). Among the symptomatic patients, the most common symptoms were dyspnoea (8/19 patients, 42.1%), palpitations (4/19 patients, 21.1%), ischaemic stroke (3/19 patients, 15.8%), syncope (2/19 patients, 10.5%) and systemic symptoms (2/19 patients, 10.5%). In our study, there was a total of 15 (44.1%) asymptomatic cardiac myxoma patients. The majority (13/15 patients) were diagnosed incidentally during imaging for reasons such as pre-operative cardiac evaluation for non-cardiac surgery and routine health screenings. Of these, eight patients were diagnosed by pre-operative echocardiography, three by CT scanning and two by chest X-ray. Intra-operative and postoperative data of the patients are summarised in Table 3. There was no statistically significant difference between the groups in terms of summarised data. As a surgical approach, we performed a left atriotomy in 18 patients (52.9%), a right atriotomy in nine patients (26.5%), a transseptal approach with right atriotomy in four patients (11.8%), and the myxoma was resected by performing both right and left atriotomy in three patients (8.8%). In 14 cases, the area of attachment of the myxoma was excised in full thickness. The defect formed in these patients who Table 1. Clinical characteristics of patients with symptomatic and asymptomatic cardiac myxomas Patients’ characteristics All cardiac myxomas (n = 34) Group 1 symptomatic myxomas (n = 19) Group 2 asymptomatic myxomas (n = 15) p-value Age, years (mean ± SD) 54.8 ± 8.8 53.9 ± 8.7 55.3 ± 9.2 0.67** Male, n (%) 18 (52.9) 8 (44.4) 10 (55.6) 0.15* Female, n (%) 16 (47.1) 11 (68.7) 5 (31.3) Hypertension, n (%) 13 (38.2) 8 (42.1) 5 (33.3) 0.60* Diabetes mellitus, n (%) 10 (32.4) 6 (31.6) 5 (33.3) 0.91* Smoking, n (%) 18 (52.9) 12 (63.2) 6 (40.0) 0.18* Hyperlipidaemia, n (%) 13 (38.2) 9 (47.4) 4 (26.7) 0.22* BMI (kg/m2) (mean ± SD) 26.5 ± 1.8 26.7 ± 1.6 26.2 ± 2.1 0.43** Ejection fraction (%) (mean ± SD) 55.3 ± 7.8 53.7 ± 8.1 57.2 ± 7.1 0.20** Location of myxoma, n (%) Left atrium 25 (73.5) 13 (68.4) 12 (80.0) 0.45* Right atrium 9 (26.5) 6 (31.6) 3 (20.0) BMI: body mass index. *Pearson’s chi-squared test, **Student’s t-test. Table 2. Pre-operative blood results and haematological parameters of patients with symptomatic and asymptomatic cardiac myxomas Blood results and haematological parameters All cardiac myxomas (n = 34) (mean ± SD) Group 1 symptomatic myxomas (n = 19) (mean ± SD) Group 2 asymptomatic myxomas (n = 15) (mean ± SD) p-value Pre-operative Haemoglobin (mg/dl) 12.92 ± 0.95 12.87 ± 0.84 12.99 ± 1.11 0.73* Creatinine (mg/dl) 0.76 ± 0.28 0.83 ± 0.29 0.68 ± 0.24 0.11* Urea (mg/dl) 40.53 ± 3.54 40.21 ± 3.10 40.93 ± 4.11 0.56* Leucocyte counts (× 103 cells/μl) 8.28 ± 1.89 8.13 ± 1.92 8.46 ± 1.91 0.62* Thrombocyte counts (× 103 cells/μl) 235 ± 48 228 ± 47 245 ± 49 0.30* CRP (mg/l) 0.87 ± 0.54 0.88 ± 0.52 0.85 ± 0.57 0.87* ESR (mm/h) 16.00 ± 7.30 18.47 ± 7.28 12.87 ± 6.23 0.02* Postoperative Haemoglobin (mg/dl) 8.91 ± 0.92 9.08 ± 1.03 8.69 ± 0.73 0.22* Creatinine (mg/dl) 0.95 ± 0.27 1.01 ± 0.32 0.88 ± 0.17 0.15* Urea (mg/dl) 43.29 ± 5.41 44.63 ± 6.38 41.60 ± 3.36 0.11* Leucocyte counts (× 103 cells/μl) 12.23 ± 2.19 12.48 ± 2.07 11.91 ± 2.36 0.45* Thrombocyte counts (× 103 cells/μl) 346 ± 57 354 ± 50 337 ± 64 0.39* CRP (mg/l) 40.84 ± 7.42 39.74 ± 8.44 42.23 ± 5.85 0.34* ESR (mm/h) 41.88 ± 7.16 42.84 ± 7.10 40.67 ± 7.30 0.39* CRP: C-reactive protein, ESR: erythrocyte sedimentation rate. *Student’s t-test.
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