[Left atrial myxoma. Clinical and surgical features in 26 surgically treated cases]

Left atrial myxomas are the most common benign intracardiac tumors. The aim of this study was to compare our experience with the data reported in the literature.

Between May 1985 and August 1999, 26 patients (8 males, 18 females) with left atrial myxomas underwent surgical resection of these tumors at the Department of Cardiac Surgery, Ospedali Riuniti of Bergamo (Italy). Symptoms included congestive heart failure, dyspnea, arrhythmias, chest pain and syncope. Diagnosis was established preoperatively in all patients by echocardiography and angiocardiography was performed in 8 cases. All tumors were excised with a wide margin of uninvolved atrial septum. Two patients underwent concomitant coronary artery bypass.

There was 1 early death due to irreversible ventricular fibrillation. Follow-up was completed for the 25 late survivals. Three patients died, years after operation, due to extracardiac causes. One patients had recurrence of the tumor, which was successfully removed 4 years after initial operation. All other patients are asymptomatic and free from disease.

Operation for left atrial myxoma can be undertaken solely on the basis of echocardiographic findings, but coronary angiography should be performed in older patients who are at risk for coronary artery disease. Surgical excision of left atrial myxomas must be performed as soon as possible after diagnosis is established because of the high risk of valvular obstruction or systemic embolization. Biatrial approach allows for the inspection of the four cardiac chambers, limits manipulation of the mass, and facilitates the complete excision of the tumor. Thus, surgical intervention can be curative for patients with left atrial myxomas and most of these can expect an excellent outcome. Since late recurrence, although rare, has been reported, especially in familial myxomas, long-term clinical and echocardiographic follow-up is recommended.