Atrial Myxoma Treatment & Management

Updated: Jan 25, 2017
  • Author: Gyanendra K Sharma, MD, FACC, FASE; Chief Editor: Richard A Lange, MD, MBA  more...
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Treatment

Approach Considerations

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. [34]  A case report of total endoscopic robotic resection of a left atrial myxoma in an elderly patient with persistent left superior vena cava also demonstrated good outcome. [35]

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Medical Care

Generally, evaluation can be performed on an outpatient basis. Following resection, obtain annual transthoracic echocardiograms to assess for 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.

Consultations

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.

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Surgical Care

Operative resection of the myxoma is the treatment of choice.

The surgery is associated with an early postoperative mortality of 2.2%. Postoperative atrial fibrillation is seen in 23-33% of patients. [36, 37] In a series of 91 cases of atrial myxoma, postsurgical neurologic complications were seen in 3% of cases, and reexploration for bleeding was required in 5% of cases. [37]

Because of the risk of tumor fragmentation and embolization, vigorous palpation or manipulation of the myxoma 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. [38] The recurrence rate is 1-5%. Recurrence after 4 years is uncommon. The recurrence rate of familial patients is 20-25%. Primary myxoma occurring at an atypical position is more likely to be associated with recurrence. [39]

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. [40]

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 often 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. [41]

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Long-Term Monitoring

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. [42]

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