Atrial myxomas: a review of clinical experience in 40 patients

We have reviewed the Mayo Clinic experience in the diagnosis and management of 40 cases of atrial myxoma seen over a 20-year period, 1957 to 1977. The diagnosis of atrial myxoma was seldom made clinically on the basis of history, physical examination, chest roentgenogram, or electrocardiogrammthere was no reduction in the time interval from onset of symptoms to operation between patients seen in the period 1957-1967 and those seen in 1968-1977. Although myxomas are rare, they should be considered in the differential diagnosis of patients with suspected mitral valve disease and congestive heart failure or constitutional disturbances who are in sinus rhythm. The greater number of patients diagnosed preoperatively in the second 10-year period, 1968-1977, reflects the introduction of echocardiography as a noninvasive diagnostic procedure. Echocardiography should be performed on all young patients with embolic disease and on those in whom the diagnosis of myxoma needs to be ruled out before exploratory or definitive surgery is undertaken so that unnecessary and potentially serious complications can be avoided. Surgical excision of the myxoma can be performed with low mortality (1 death occurred in 37 cases or 2.7%), and it provides excellent and sustained symptomatic relief. The recurrence rate is low (5.4%), but long-term follow-up and serial echocardiography are advisable.