Surgical Treatment of Cardiac Tumors: A Single Institutional Experience Over 12 Years

Introduction: Tumors of the heart represent an exceedinglyrare entity in cardiac surgery and literature regardingmanagement and outcome is less in comparison to other fieldsof cardiac surgery. 12 years of our experience in both diagnosisand optimal surgical treatment of this small but rare collectionof patients was formed into a detailed analysis of patientprognosis, mean survival and risk of tumor relapse matchedto the corresponding pathology. The overall objective of thepresent study was a thorough characterization of both primarycardiac tumor or tumor like mass and secondary malignanttumor mass in cardiac chambers, their nature as well as ageand gender distribution and management.Material and methods: 17 patients with cardiac tumors,who underwent open-heart surgery at Medical College andHospitals, Kolkata, for tumor excision between 2007 and2019 were analyzed retrospectively. Mean follow-up wasfrom 11 to 1 years.Results: There were 2 males and 15 female patients rangingin age from 7 years to 60 years, median age being 47 years.12 of these tumors were primary left atrial myxoma, 2 wereright atrial myxoma, 1 was right ventricular fibroma, 1 wasintravenous extension into right atrium of renal cell carcinomaand 1 was multiple inflammatory pseudo tumors in leftventricle. Overall operative survival was 88.3%. Operativemortality was 11.7%.Conclusion: Cardiac tumors remain challenging in theclinical setting. Early operation is recommended afterechocardiographic diagnosis as such patients can have suddendeath or severe cardiac failure during preoperative waitingperiod. Follow up should be maintained based upon thehistopathological diagnosis.

Left atrial myxoma - A tumor in transit

Cardiac myxoma is the most common type of primary cardiac neoplasm. Over 70% of all cardiac myxomas originate from the left atrium (LA) and 18% from the right atrium (RA). Most myxomas present with constitutional, embolic, and obstructive manifestations. We are presenting a case where a part of myxoma got embolized intra-operatively. Using trans-oesophageal echocardiography, we were able to diagnose and image the transit of the tumor from the left ventricle to the left atrium. We removed the embolized tumor from the left atrium and prevented a dreaded complication like stroke, mesenteric ischemia, renal infarct or limb ischemia, which would have resulted in increased morbidity or mortality of the patient.

Determination of residual mass in left ventricle by intraoperative transesophageal echocardiography after a giant and floating left atrial myxoma resection / Determinação da massa residual em ventrículo esquerdo por ecocardiografia transesofágica intraoperatória após ressecção de mixoma gigante e flutuante em átrio esquerdo

Abstract Atrial myxoma is a benign tumor of the heart that occurs primarily in the left atrium. Floating or large left atrial myxomas frequently cause functional mitral stenosis, may also affect mitral valve structure and flow, and lead to mitral regurgitation. Systemic embolization occurs in around 30% of cases either from tumor fragmentation or complete tumor detachment hence it should be removed as soon as it is detected. Intraoperative transesophageal echocardiography has a vital importance in the surgery. After resection of myxoma, intraoperative transesophageal echocardiography must be performed to rule out residual mass. The case here reported is of a 48-year old female, who presented with giant and floating left atrial myxoma. Residue mass was detected with intraoperative transesophageal echocardiography in the left ventricle after the resection of myxoma. Subsequently, the residue mass was successfully removed. Complete resection must be required to prevent possible complications such as recurrence, embolization in atrial myxomas. Transesophageal echocardiography performed intraoperatively is vital importance to confirm that the myxoma is completely resected.

Resumo Mixoma atrial é um tumor benigno do coração que ocorre principalmente no átrio esquerdo. Os mixomas flutuantes ou grandes em átrio esquerdo com frequência causam estenose mitral funcional, podendo também afetar a estrutura e o fluxo da válvula mitral e levar à insuficiência mitral. A embolização sistêmica ocorre em cerca de 30% dos casos, quer pela fragmentação do tumor ou pelo desprendimento total do tumor; portanto, o tumor deve ser removido assim que detectado. A ecocardiografia transesofágica intraoperatória tem uma importância vital na cirurgia. Após a ressecção do mixoma, a ecocardiografia transesofágica intraoperatória deve ser feita para excluir a massa residual. O caso aqui relatado é o de uma paciente de 48 anos que apresentou um mixoma de átrio esquerdo gigante e flutuante. A massa residual foi detectada com ecocardiografia transesofágica intraoperatória no ventrículo esquerdo após a ressecção do mixoma. Posteriormente, a massa residual foi removida com sucesso. A ressecção completa é necessária para evitar possíveis complicações, como recorrência e embolização em mixomas atriais. A ecocardiografia transesofágica realizada no intraoperatório é de vital importância para confirmar a ressecção completa do mixoma.

Floating Bodies in the Left Atrium by 2D-echo: A Differential Diagnosis.

Two-dimensional echocardiography (2D-echo) is sensitive in detecting floating bodies in the left atrium. Identification of a freefloating left atrial thrombus, as a source of embolus, is a common indication for 2D-echo. Screening for other cardiac conditions such as valvular heart diseases often, if not common, reveal floating bodies in the left atrium. The differential diagnosis of a floating body in the left atrium will be discussed.

Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease.

Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre‑operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra‑operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

A Case of Minimally Invasive Cardiac Surgery by the Small Right Intercostal Thoracotomy for Left Atrial Myxoma after Substernal Reconstruction of the Esophagus / 日本心臓血管外科学会雑誌

We report a case of minimally invasive cardiac surgery treated by small right intercostal thoracotomy for left atrial myxoma after substernal reconstruction of the esophagus using gastric interposition. This technique could not only alleviated risk at the second median sternotomy, but was also minimally invasive. A 63-year old man was admitted to our hospital for complaints of right upper limb asthenia and slight fever. Computed tomography showed cerebral infarction. Moreover, cardiac ultrasonography showed a giant myxoma in the left atrium. We thought that it was impossible to reperform median sternotomy, because there was high risk of injury to the reconstructed esophagus using a gastric duct behind the sternum. The patient underwent excision of the myxoma by the right intercostal thoracotomy approach, and did well. He was discharged from the hospital without any complications.

Reversible Pulmonary Hypertension in Adolescent with Left Atrial Myxoma

We report a patient of left atrial huge myxoma presenting with severe pulmonary hypertension in adolescents. A patient was a 14-year-old boy presented with sudden onset dyspnea. Transthoracic echocardiographic study revealed the presence of a nodular, 4.34 x 8.11 cm sized, mobile, hyperechoic mass in the left atrium and severe pulmonary hypertension with tricuspid insufficiency. After surgical therapy, tricuspid regurgitation and pulmonary hypertension was decreased and the patient was stabilized and had an uneventful clinical course.

A case of sinus node dysfunction and atrial tachycardia after the excision of a left atrial myxoma / 대한내과학회지

Atrial myxoma is the most common primary cardiac tumor, and surgical removal is the treatment of choice. Atrial flutter-fibrillation is common after the surgical excision of such tumors, whereas sinus node dysfunction is a rare complication. We detected postoperative sinus node dysfunction and atrial tachycardia after the excision of a left atrial myxoma in a 63-year-old woman. The patient underwent the implantation of a permanent pacemaker two weeks after the operation. The patient underwent successful catheter ablation of macroreentrant right atrial tachycardia 16 months after the operation with no recurrence of atrial tachycardia over the next four months.

A Case of Left Atrial Myxoma in a 15-year-old Female Chiefly Complaining of Abdominal Symptoms / General Medicine

We describe our experience with a left atrial (LA) myxoma in a 15-year-old female who experienced abdominal symptoms so prominent that she was initially thought to have an inflammatory enterocolitis.<BR>The patient's young age and predominant abdominal symptoms in the absence of any cardiac symptoms made it difficult to diagnose the LA myxoma early in the present case. This experience underscores the need for an intensive search for cardiac myxomas in patients with findings suggestive of inflammatory diseases or collagen disorders.