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[Surgical treatment of left atrial myxoma with concomitant acquired heart disease]
1Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
Insights
Left atrial myxoma patients sometimes require additional cardiac surgery for co-existing heart conditions. Successful surgical management of these complex cases, including coronary artery bypass grafting and valve repair, is achievable.
Area of Science:
- Cardiovascular Surgery
- Cardiac Oncology
- Cardiology
Background:
- Left atrial myxoma is a primary cardiac tumor.
- Associated acquired heart disease can complicate myxoma management.
- Surgical intervention is the primary treatment for left atrial myxoma.
Observation:
- Three out of 21 patients with left atrial myxoma had associated acquired heart disease requiring concomitant cardiac surgery.
- Two patients with coronary arterial disease underwent coronary artery bypass grafting (CABG) after myxoma removal.
- One patient with severe mitral and tricuspid regurgitation underwent valve repair/replacement alongside myxoma removal.
Findings:
- Concomitant cardiac surgery for associated conditions in left atrial myxoma patients is feasible.
- Retrograde coronary perfusion facilitated CABG after myxoma resection.
- Surgical correction of valvular dysfunction and myxoma removal led to good outcomes.
Implications:
- Comprehensive surgical planning is crucial for patients with left atrial myxoma and co-existing heart disease.
- Multidisciplinary approaches can improve outcomes in complex cardiac tumor cases.
- Further research into optimal surgical sequencing and techniques is warranted.
Abstract:
Among 21 patients with left atrial myxoma treated during the past 11 years in our institute, 3 patients had associated acquired heart disease which required concomitant cardiac surgery. Two patients had atherosclerotic coronary arterial disease, and underwent single coronary artery bypass grafting (CABG) and 4 CABGs in addition to removal of myxoma, respectively. Both of them received CABGs after removal of myxoma, because the intraoperative heart protection using retrograde coronary perfusion could afford the situation. Another patient had a huge left atrial myxoma associated with mitral and tricuspid regurgitation. She suffered from sudden heart failure caused by tumor obstruction of blood flow across the mitral valve, and an emergency surgery was performed. She underwent mitral valve replacement for annular dilatation with prolapse of both leaflets and tricuspid annuloplasty for annular dilatation, in addition to removal of myxoma. All of these 3 patients went a good postoperative course and are doing well now with no local recurrence. In this paper, preoperative and intraoperative evaluation, and surgical treatment of associated heart disease with left atrial myxoma were discussed.