Atrial Myxoma Treatment & Management

  • Author: Gyanendra K Sharma, MD, FACC, FASE; Chief Editor: Park W Willis IV, MD   more...
 
Updated: Aug 30, 2011
 

Medical Care

  • Generally, evaluation can be performed on an outpatient basis.
  • 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.
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Surgical Care

  • 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. In one series, 33% patient had postoperative atrial fibrillation.[18]
  • 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.[19]
    • The recurrence rate is 1-5%. Recurrence after 4 years is uncommon.
    • The recurrence rate of familial patients is 20%.
  • 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: Deshpande et al have reported 27 cases (23 myxomas) of endoscopic cardiac tumor resection using the port access approach. Follow-up did not show any residual or recurrent tumor. This is an alternate approach that has cosmetic appeal and was appreciated by 92 of the patients.[20]
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Consultations

If myxoma is suspected, a cardiologist should be consulted and a cardiothoracic surgical consultation will be required for consideration of resection.

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Diet

No special diet is required.

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Activity

Patients may engage in activities as tolerated.

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Contributor Information and Disclosures
Author

Gyanendra K Sharma, MD, FACC, FASE  Professor, Department of Medicine, Section of Cardiology, Medical College of Georgia, Georgia Health Sciences University

Gyanendra K Sharma, MD, FACC, FASE is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Fowles, MD  Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, Intermountain Medical Center and LDS Hospital; Director and Consulting Staff, Department of Cardiology, Salt Lake Clinic

Robert E Fowles, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steven J Compton, MD, FACC, FACP  Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Park W Willis IV, MD  Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine

Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Nothing to disclose.

References

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