CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 30 AFRICA underwent full-thickness resection was repaired with a pericardial patch in five patients (Fig. 2). In the other nine patients, the defect was primarily sutured. Associated procedures consisted of coronary artery bypass grafting in two patients, coronary artery bypass grafting and the Bentall procedure in one patient, mitral valve replacement in two patients, and mitral valve replacement and tricuspid valve reconstruction in one patient. Arrhythmia was observed in seven patients (20.6%) in the early postoperative period. Of these, transient nodal rhythm was found in three patients (8.8%) and transient atrial fibrillation in four patients (11.8%) who successfully converted to sinus rhythm after intravenous infusion of amiodarone. None of these patients required permanent pacemaker implantation. Neurological events (transient ischaemic event, speech disorder, hemiplegia or hemiparesis) in the first month postoperatively were seen in two patients (10.5%) in group 1 and in one (6.7%) in group 2. There was no statistically significant difference between the groups (p = 0.69). There was no mortality in any patient in hospital and in the first month postoperatively. However, in our long-term follow up, one patient died due to an oncological disease in the 93rd month of follow up, and another died in the 118th month of follow up due to multiple organ failure. Other postoperative complications were sternum wound infection in two patients and pericardial effusion requiring re-sternotomy in two patients with tamponade findings. Tumours resected from all patients were submitted for histological examination. The diagnosis of myxoma was confirmed by extensive fibrin deposits, proliferation of capillaries, and blood extravasations (Fig. 3). Discussion In this study, we present our 16-year experience of cardiac myxoma from two hospitals that provide tertiary care and are also cardiac centres. Autopsy studies have determined the incidence of primary cardiac neoplasms to be approximately two in 10 000 and the majority of them histologically benign.10 Cardiac myxomas are the most common primary benign tumour of the heart, most common between the fourth and sixth decades of life, and more common in women.11 In our study, the mean age of the patients at the time of surgery was 54.5 ± 8.8 years, which is in line with that of the literature. The incidence of myxoma in our study was also similar to that of other studies. Myxomas are usually solitary and originate from the left atrium (75%) or from the atrial septum close to the foramen ovale, but with decreasing frequency, they can also originate from the posterior atrial wall, anterior atrial wall and atrial Table 3. Intra-operative and postoperative data of the patients Patients’ characteristics All cardiac myxomas (n = 34) Group 1 symptomatic myxomas (n = 19) Group 2 asymptomatic myxomas (n = 15) p-value Duration of surgical intervention (days) (mean ± SD) 31.79 ± 24.22 17.79 ± 6.36 49.53 ± 26.97 0.0001* ACC time (min) (mean ± SD) 37.97 ± 16.97 36.53 ± 11.80 39.80 ± 20.22 0.58* CPB time (min) (mean ± SD) 62.62 ± 22.93 60.74 ± 14.96 65.00 ± 30.67 0.60* Amount of drainage (ml) (mean ± SD) 349 ± 134 366 ± 114 340 ± 105 0.45* Intubation time (hours) (mean ± SD) 5.85 ± 1.35 5.79 ± 1.48 5.93 ± 1.22 0.76* Stay in ICU (hours) (mean ± SD) 24.06 ± 6.26 25.00 ± 6.84 22.87 ± 5.42 0.33* Duration of hospital stay (days) (mean ± SD) 6.21 ± 1.72 6.47 ± 1.58 5.87 ± 1.89 0.31* Use of blood products, n (%) 16 (47.1) 7 (43.8) 9 (56.3) 0.18** Use of inotropic support, n (%) 10 (29.4) 17 (9.3) 36 (5.9) 0.20** Follow-up times (months) (mean ± SD) 113.79 ± 44.11 109.84 ± 44.32 118.73 ± 44.87 0.57* ACC: aortic cross-clamp, CPB: cardiopulmonary bypass, ICU: intensive care unit. *Student’s t-test, **Pearson’s chi-squared test. Fig. 2. Myxoma attached to the interatrial septum and excised with septal tissue in full thickness. Fig. 3. Histopathological image of the excised myxoma.
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