J Cardiovasc Imaging.  2019 Jan;27(1):37-47. 10.4250/jcvi.2019.27.e7.

Twenty Years of Clinical Experience with Cardiac Myxomas: Diagnosis, Treatment, and Follow Up

• Cianciulli TF
• Cozzarin A
• Soumoulou
• Saccheri M
• Méndez RJ
• Beck MA
• Gagliardi
• Lax JA

• KMID: 2433763
• DOI: http://doi.org/10.4250/jcvi.2019.27.e7

Abstract

BACKGROUND
Cardiac myxomas are the most frequent cardiac tumors. Although histologically benign, in some cases myxomas may be lethal, due to impairment of cardiac dynamics and their thromboembolic potential. The study aimed to assess the clinical presentation of cardiac myxomas and their correlation with echocardiographic features and to describe the perioperative results and long-term outcome of surgically treated patients.
METHODS
A prospective study of 53 patients with cardiac myxomas who were operated the Hospital Argerich, followed clinically and with echocardiography from 1993 until 2013. All patients underwent echocardiographic studies.
RESULTS
The patient's mean age was 53 ± 16 years (62.3% were women). The most common findings were dyspnea followed by embolic events. Most tumors were localized in the left atrium (77.4%), mainly in the fossa ovalis (63%). Mean size of the tumors was 4.76 x 3.50 cm. Tumors were generally mobile (88%) and went beyond the valve plane, causing mild mitral or tricuspid valve obstruction (58%) and dilation of the respective atrial chamber. Patients whose tumors were obstructive had higher pulmonary artery systolic pressures (50 vs 33 mmHg p < 0.01). According to the echocardiographic appearance 67% of tumors had a smooth surface and the remaining 32% had a villous surface. All patients with embolic manifestations had tumors with a villous surface.
CONCLUSIONS
Clinical presentation relates to the ultrasound characteristics of myxomas. Smooth tumors are larger, occur with obstructive symptoms, and benefit from an elective surgery, whereas villous myxomas entailed a high embolic risk and require prompt surgical treatment.

Keyword

Myxoma; Villous myxoma; Smooth myxoma; Risk of embolism; Surgery

MeSH Terms

Diagnosis*
Dyspnea
Echocardiography
Follow-Up Studies*
Heart Atria
Heart Neoplasms
Humans
Myxoma*
Prospective Studies
Pulmonary Artery
Tricuspid Valve
Ultrasonography

Figure

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  Figure 1 Smooth myxoma: surgical specimen (A), transesophageal echocardiogram (B). Villous myxoma: surgical specimen (C), transesophageal echocardiogram (D).

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  Figure 2 Biatrial villous myxoma (arrows). Transesophageal echocardiogram, 4-chamber view. LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

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  Figure 3 Histology of left atrial myxoma. Optic microscopy. (A) Hematoxylin–eosin stain. Proliferation of spindle and stellate mesenchymal cells around thin-walled vessels, with recent hemorrhage and macrophages filled with hemosiderin. Myxoid matrix with thin capillaries. (B) Microphotograph showing myxoid background, proliferation of star shaped cells, thin-walled vessels and macrophages with hemosiderin.

• 

  Figure 4 Left atrial myxoma with intra-tumor calcification. Transesophageal echocardiogram, 4-chamber view. The presence of calcification inside the tumor causes acoustic shadowing (arrow). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

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