Cardiac myxoma - clinical presentation and long-term post-operative follow-up

Myxoma is the commonest cardiac neoplasm. Due to varying symptomatology, its diagnosis can prove difficult. It is agreed to have an excellent prognosis.

Assessing the clinical course in patients operated on due to cardiac myxoma in two departments of cardiac surgery over the course of a decade.

The medical records of patients operated on due to cardiac myxoma between 1999 and 2009 were analysed. The patients were then invited for an ambulatory visit, during which transthoracic and transoesophageal echocardiographic examinations were performed.

There were 61 patients (47 females) with histologically confirmed myxoma operated upon. The commonest symptoms leading to diagnosis were heart failure (16 patients, 26%) and syncope (12 patients, 20%). There were five (8%) in-hospital deaths and two (3%) non-fatal strokes. Follow-up duration ranged between one and ten years (6.1 ± 3.2 years). Nine (15%) deaths occurred during follow-up. In four (7%) patients, myxoma recurred in the original location. Echocardiography performed at follow-up visit revealed one recurrence of myxoma, and minor pathologies in 20 patients. Patients who died perioperatively were significantly older compared to those who survived (69 ± 9.7 years vs 56 ± 13, p = 0.02). Patients who died during the follow-up were also significantly older than those who were alive at the time of the contact visit (65 ± 15 years vs 56 ± 12, p = 0.02). Death during follow-up occurred four times more often in males than females (36% vs 8.5%, p = 0.02). There were more deaths during the follow-up in patients whose initial presenting symptom was dyspnea: five deaths (31%) vs four deaths (9%, p = 0.04). The recurrence of myxoma was significantly more frequent in patients with a shorter duration of symptoms before the operation: 8.6 ± 15 weeks with relapse vs 33.9 ± 40 weeks without relapse (p = 0.04).

Both, serious and benign events following myxoma excision are common. Clinical and echocardiographic surveillance should be implemented in all patients who undergo a myxoma operation.