Atrial Myxoma Treatment & Management
- Author: Gyanendra K Sharma, MD, FACC, FASE; Chief Editor: Park W Willis IV, MD more...
Conventional treatment of atrial myxoma is surgical removal by median sternotomy. Minithoracotomy with robotically assisted surgery has been reported, resulting in a shorter length of hospital stay, and it is considered a safe and feasible method for atrial myxoma excision. The investigators did not observe any difference in the quality of life between the two strategies.
Generally, evaluation can be performed on an outpatient basis. Obtain annual transthoracic echocardiography to assess for the recurrence of the tumor
A patient with embolic stroke requires hospitalization.
No known medical treatment exists for atrial myxoma. Drug therapy is used only for complications such as congestive heart failure or cardiac arrhythmias.
If myxoma is suspected, a cardiologist should be consulted and a cardiothoracic surgical consultation will be required for consideration of resection.
Diet and activity
Patients with atrial myxoma do not require a special diet, and they may engage in activities as tolerated.
Operative resection of the myxoma is the treatment of choice.
The surgery is safe, with an early postoperative mortality of 2.2%. Some authorities believe resection should be performed immediately after the diagnosis is made. Postoperative atrial fibrillation is seen in 23-33% of patients.[29, 30] In a series of 91 cases of atrial myxoma, postsurgical neurologic complications were seen in 3% of cases, and the exploration for bleeding was required in 5% of cases.
Because of the risk of tumor fragmentation and embolization, vigorous palpation or manipulation should be performed only after cardioplegia.
Surgery for sporadic atrial myxoma is usually curative. Long-term prognosis is excellent. In a series of 112 patients, only 4 deaths occurred over a median follow-up of 3 years. The recurrence rate is 1-5%. Recurrence after 4 years is uncommon. The recurrence rate of familial patients is 20%. Primary myxoma occurring at an atypical position is more likely to be associated with recurrence.
In a series of 194 patients, operative mortality was 0.5%, and there was no significant difference in the long-term survival (10, 20, 30 y) when compared to an age-matched general population. Older age at operation was associated with a higher mortality, whereas younger age at diagnosis, smaller tumor dimension, and tumor localized to the ventricles were predictors of recurrence.
Note the following:
Recurrence is usually attributed to incomplete excision of the tumor, growth from a second focus, or intracardiac implantation from the primary tumor.
Wider resection of the stalk attachment to the endocardium may reduce the burden of pretumorous cells.
A cloth patch or parietal pericardium is used to close the surgical defect.
Pretumorous cells around the stalk should be destroyed by laser photocoagulation. This obviates the need for a wide surgical resection.
To fully visualize both sides of the heart, some surgeons recommend a biatrial approach.
Damaged valves may require annuloplasty or prosthetic replacement.
Biannual echocardiograms are useful for early detection of recurrent tumors.
Endoscopic cardiac tumor resection
In a study of 27 cases (23 myxomas) of endoscopic cardiac tumor resection using the port access approach, Deshpande et al reported that follow-up did not show any residual or recurrent tumor. This is an alternative approach that has cosmetic appeal and was appreciated by 92% of the patients.
In younger patients or patients with suspected Carney complex, the possibility of myxoma recurrence is high and it may be reasonable to do a biannual transthoracic echocardiogram to evaluate for recurrence of the tumor. However, in a report of 82 patients with a mean echocardiographic follow-up of 72 months, there were no myxoma recurrences. Therefore, the echocardiographic follow-up in all patients following surgery could be called into question.
Larsson S, Lepore V, Kennergren C. Atrial myxomas: results of 25 years' experience and review of the literature. Surgery. 1989 Jun. 105(6):695-8. [Medline].
Obrenovic-Kircanski B, Mikic A, Parapid B, et al. A 30-year-single-center experience in atrial myxomas: from presentation to treatment and prognosis. Thorac Cardiovasc Surg. 2013 Sep. 61(6):530-6. [Medline].
Ha JW, Kang WC, Chung N. Echocardiographic and morphologic characteristics of left atrial myxoma and their relation to systemic embolism. Am J Cardiol. 1999. 83:1579-1582. [Medline].
Hasdemir H, Alper AT, Arslan Y, Erdinler I. [Left atrial myxoma with severe neovascularization: role of preoperative coronary angiography]. Turk Kardiyol Dern Ars. 2011 Mar. 39(2):163-5. [Medline].
Park J, Song JM, Shin E, Jung SH, Kim DH, Kang DH, et al. Cystic cardiac mass in the left atrium: hemorrhage in myxoma. Circulation. 2011 Mar 15. 123(10):e368-9. [Medline].
Sakamoto H, Sakamaki T, Kanda T, Tsuchiya Y, Sato M, Sato H. Vascular endothelial growth factor is an autocrine growth factor for cardiac myxoma cells. Circ J. 2004 May. 68(5):488-93. [Medline].
Mendoza CE, Rosado MF, Bernal L. The role of interleukin-6 in cases of cardiac myxoma. Clinical features, immunologic abnormalities, and a possible role in recurrence. Tex Heart Inst J. 2001. 28(1):3-7. [Medline].
Kono T, Koide N, Hama Y, et al. Expression of vascular endothelial growth factor and angiogenesis in cardiac myxoma: a study of fifteen patients. J Thorac Cardiovasc Surg. 2000 Jan. 119(1):101-7. [Medline].
Imai Y, Taketani T, Maemura K, Takeda N, Harada T, Nojiri T. Genetic analysis in a patient with recurrent cardiac myxoma and endocrinopathy. Circ J. 2005 Aug. 69(8):994-5. [Medline].
Zheng JJ, Geng XG, Wang HC, Yan Y, Wang HY. Clinical and histopathological analysis of 66 cases with cardiac myxoma. Asian Pac J Cancer Prev. 2013. 14(3):1743-6. [Medline].
Li H, Guo H, Xiong H, Xu J, Wang W, Hu S. Clinical features and surgical results of right atrial myxoma. J Card Surg. 2015 Nov 19. [Medline].
Aggarwal SK, Barik R, Sarma TC, Iyer VR, Sai V, Mishra J. Clinical presentation and investigation findings in cardiac myxomas: new insights from the developing world. Am Heart J. 2007 Dec. 154(6):1102-7. [Medline].
Patil NP, Dutta N, Satyarthy S, Geelani MA, Kumar Satsangi D, Banerjee A. Cardiac myxomas: experience over one decade. J Card Surg. 2011 Jul. 26(4):355-9. [Medline].
Pergolini A, Zampi G, Sbaraglia F, Musumeci F. Left atrial myxoma: two sides of the same coin. J Cardiovasc Med (Hagerstown). 2013 Jun 7. [Medline].
Jha GN. Ascites--rare manifestation of right atrial myxoma. J Assoc Physicians India. 2014 Apr. 62(4):349-50. [Medline].
Lee VH, Connolly HM, Brown RD Jr. Central nervous system manifestations of cardiac myxoma. Arch Neurol. 2007 Aug. 64(8):1115-20. [Medline].
Singh PK, Sureka RK, Sharma AK, Bhuyan S, Gupta V. Recurrent stroke in a case of left atrial myxoma masquerading vasculitis. J Assoc Physicians India. 2013 Dec. 61(12):912, 917-20. [Medline].
Smith MJ, Chaudhry MA, Humphrey MB, Lozano PM. Atrial myxoma and bone changes: a paraneoplastic syndrome?. J Card Surg. 2011 Jul. 26(4):375-7. [Medline].
Furukawa A, Kishi S, Aoki J. Large Infected Atrial Myxoma With Vegetations. Rev Esp Cardiol. 2011 Jul 21. [Medline].
Lanjewar DN, Bhatia VO, Lanjewar SD, Carney JA. Cutaneous myxoma: An important clue to Carney complex. Indian J Pathol Microbiol. 2014 Jul-Sep. 57(3):460-2. [Medline].
Ryou KS, Lee SH, Park SH, Park J, Hwang SK, Hamm IS. Multiple fusiform myxomatous cerebral aneurysms in a patient with Carney complex. J Neurosurg. 2008 Aug. 109(2):318-20. [Medline].
Scheffel H, Baumueller S, Stolzmann P, Leschka S, Plass A, Alkadhi H. Atrial myxomas and thrombi: comparison of imaging features on CT. AJR Am J Roentgenol. 2009 Mar. 192(3):639-45. [Medline].
Gheysens O, Cornillie J, Voigt JU, Bogaert J, Westhovens R. Left Atrial Myxoma on FDG-PET/CT. Clin Nucl Med. 2013 Mar 18. [Medline].
Hajj-Chahine J, Jayle C, Houmaida H, Corbi P. Utility of genetic testing in multisite myxoma to rule out Carney complex. Interact Cardiovasc Thorac Surg. 2011 Apr. 12(4):624. [Medline].
Acebo E, Val-Bernal JF, Gomez-Roman JJ, Revuelta JM. Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience. Chest. 2003 May. 123(5):1379-85. [Medline].
Lopez-Marco A, BinEsmael T, Rowlands G, Von Oppell U. Complete calcification of right atrial myxoma. Eur J Cardiothorac Surg. 2014 Oct 25. [Medline].
Kesavuori R, Raivio P, Jokinen JJ, Sahlman A, Vento A. Quality of life after robotically assisted atrial myxoma excision. J Robot Surg. 2015 Sep. 9 (3):235-41. [Medline].
Owers CE, Vaughan P, Braidley PC, Wilkinson GA, Locke TJ, Cooper GJ, et al. Atrial myxomas: a single unit's experience in the modern era. Heart Surg Forum. 2011 Apr 1. 14(2):E105-9. [Medline].
Baikoussis NG, Papakonstantinou NA, Dedeilias P, et al. Cardiac tumors: a retrospective multicenter institutional study. J BUON. 2015 Jul-Aug. 20 (4):1115-23. [Medline].
Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore). 2001 May. 80(3):159-72. [Medline].
Sheng WB, Luo BE, Liu Y, Zhang H, Zou LJ, Xu ZY, et al. Risk factors for postoperative recurrence of cardiac myxoma and the clinical managements: a report of 5 cases in one center and review of literature. Chin Med J (Engl). 2012 Aug. 125(16):2914-8. [Medline].
Shah IK, Dearani JA, Daly RC, et al. Cardiac myxomas: a 50-year experience with resection and analysis of risk factors for recurrence. Ann Thorac Surg. 2015 Aug. 100 (2):495-500. [Medline].
Deshpande RP, Casselman F, Bakir I, Cammu G, Wellens F, De Geest R. Endoscopic cardiac tumor resection. Ann Thorac Surg. 2007 Jun. 83(6):2142-6. [Medline].
Vroomen M, Houthuizen P, Khamooshian A, Soliman Hamad MA, van Straten AH. Long-term follow-up of 82 patients after surgical excision of atrial myxomas. Interact Cardiovasc Thorac Surg. 2015 Aug. 21 (2):183-8. [Medline].
Basson CT, MacRae CA, Korf B. Genetic heterogeneity of familial atrial myxoma syndromes (Carney complex). Am J Cardiol. 1997 Apr 1. 79(7):994-5. [Medline].