Cardiac myxomas: short- and long-term follow-up

Cardiac myxomas are the most frequently encountered benign intracardiac tumors, that, if left untreated, are inexorably progressive and potentially fatal. Patients with cardiac myxoma can be treated only by surgical removal. This study summarizes our experience over 22 years with these tumors.

Fifty seven patients (M/F: 14/43, age: 57.9 +/- 14.6 years) with cardiac myxomas underwent surgical resection at our institution. There were 82.4% left atrial myxomas, 14.0% right atrial myxomas, 3.6% biatrial myxomas. The duration of symptoms prior to surgery ranged from 6 to 1,373 days (median 96 days). The surgical approach comprised complete wide excision. The diagnostic methods, incidence of thromboembolic complications, valve degeneration, surgical repair techniques, recurrence and re-operation were reviewed and the Kaplan-Meier survival curve was calculated.

There were no in-hospital deaths. Hospital stay amounted to a mean of 13.7 +/- 6.9 days. Late follow-up was available for 54 (94.7%) patients for a median 7.5 years after surgery (23 days to 21.4 years). Fifty two patients are alive, while five patients had died after a mean interval of 6.3 years. Cause of death was cardiac in 40% of the patients (n = 2) and non-cardiac in the other 60% (n = 3).

Surgical excision of cardiac myxoma carries a low operative risk and gives excellent short-term and long-term results. Surgical excision of the tumor appears to be curative, with few recurrences at long-term follow-up. After diagnosis, surgery should be performed urgently, in order to prevent complications such as embolic events or obstruction of the mitral orifice. Follow-up examination, including echocardiography, should be performed regularly.