Abstract
Myxomas of the heart make up 0.0017% of the total population of patients with cardiovascular diseases. Myxomas of the heart with atypical localization are neoplasms that occur in any chambers of the heart, except for the oval fossa and the atrial septum of the LP. The frequency of atypically localized myxomas is 20–25%. The only effective method of treatment heart myxomas is radical surgical resection of the neoplasm. Excision of atypically localized myxomas can be extremely problematic if standard access for atriotomy is used without appropriate visualization. With standard surgical access, the tumor itself, surrounding tissues, and the heart's conduction system may be damaged. This literature review presents the immediate and long-term results of surgical treatment with left atrial heart myxomas and myxomas with atypical localization. Given data on different classifications. The paper describes instrumental methods for diagnosing myxoma of the heart, the advantages and disadvantages of each method, and diagnostic algorithms performed when a patient is suspected of myxoma. Presented comparative characteristics of different accesses to the heart chambers where the tumor is located. Described the results of minimally invasive surgical interventions, their advantages and disadvantages. Separately considered the results of such postoperative complications as embolic complications, relapses, and cases of atrial fibrillation. Performed the maximum possible detailed review of all cases of heart myxoma with atypical localization over a fairly long period of time.
References
- Nina V.J., Silva N.A., Gaspar S.F., Rapôso T.L., Ferreira E.C., Nina R.V. et al. Atypical size and location of a right atrial myxoma: a case report. J. Med. Case Rep. 2012; 6: 26. DOI:10.1186/1752-1947-6-26
- Bockeria L.A., Malashenkov A.I., Scopin I.I. et al. Surgical treatment of acquired heart defects and tumors in elderly patients. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2007; 8 (3): 25 (in Russ.).
- Cottini M., Pergolini A., Zampi G., Buffa V., Pino P.G., Polizzi V. et al. Posterior wall as atypical localization of left atrial myxoma. Herz. 2017; 42: 390–4. DOI: 10.1007/s00059-016-4480-y
- Kuon E., Kreplin M., Weiss W., Dahm J.B. The Challenge presented by right atrial myxoma. Herz. 2004; 29: 702–9. DOI: 10.1007/s00059-004-2571-7
- Alkuwaiti F.A., Elghoneimy Y., Chazal S. Aortic valve myxoma presenting with a strike: a case report and review of the literature. Sultan Qaboos Univ. Med. J. 2018; 18 (4): e537–40. DOI: 10.18295/squmj.2018.18.04.019
- Aguilar C., Espinoza D., Segura P., Donet J.A. Clinicopathological spectrum of mitral valve myxoma. J. Heart Valve Dis. 2017; 26 (6): 693–9.
- Yuan S.M., Shinfeld A., Raanani E. Tricuspid valve myxoma: a case report and a collective review of the literature. J. Card. Surg. 2009; 24 (1): 69–72. DOI: 10.1111/j.1540-8191.2008.00720.x
- Li Y., Li X., Wang X., Chen L. Biatrial myxoma floating like a butterfly: a case report and review of the literature. A case report and review of the literature. Medicine (Baltimore). 2018; 97 (3): e9558. DOI: 10.1097/MD.0000000000009558
- Skopin I.I., Makushin A.A., Asatryan T.V., Peskova A.S., Nersesyan I.L., Akimov I.V. Tandem myxoma of the left and right atria (clinical case). The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2010; 11 (5): 77–9 (in Russ.).
- Bockeria L.A., Malashenkov A.I., Kavsadze V.E. et al. Cardiooncology. Moscow; 2003: 13–26 (in Russ.).
- Boutayeb A., Mahfoudi L., Moughil S. Atrial myxoma: From diagnosis to management. Clin. Surg. 2017; 2: 1498.
- Garatti A., Nano G., Canziani A., Gagliardotto P, Mossuto E., Frigiola A. et al. Surgical excision of cardiac myxomas: twenty years experience at a single institution. Ann. Thorac. Surg. 2012; 93: 825–31. DOI: 10.1016/j.athoracsur.2011.11.009
- Ekmektzouglou K.A., Samelis G.F., Xanthos T. Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. J. Cardiovasc. Med. 2008; 9: 769–77. DOI: 10.2459/JCM.0b013e3282f88e49
- Grebenc M.L., Rosado-de-Christenson M.L., Green C.E., Burke A.P., Jeffrey R., Galvin J.R. Cardiac myxoma: imaging features in 83 patients. Radiographics. 2002; 22 (3): 673–89. DOI: 10.1148/radiographics.22.3.g02ma02673
- Matsumura M., Takamoto S., Kyo S., Yokote Y., Omoto R. Advantages of transesophageal color Doppler echocardiography in the diagnosis and surgical treatment of cardiac masses. J. Cardiol. 1990; 20 (3): 701–14.
- Gross B.H., Glazer G.M., Francis I.R. CT of intracardiac and intrapericardial masses. Am. J. Roentgenol. 1983; 140 (5): 903–7. DOI:10.2214/ajr.140.5.903
- Amparo E.G., Higgins C.B., Farmer D., Gamsu G., McNamara M. Gated MRI of cardiac and paracardiac masses: initial experience. Am. J. Roentgenol. 1984; 143 (6): 1151–6. DOI: 10.2214/ajr.143.6.1151
- Crafoord C. Discussion of Glover R.P. The technique of mitral commissurotomy. In: Lam C.R. (Ed.) Henry Ford Hospital: International Symposium on Cardiovascular Surgery. Philadelphia: Saunders; 1955: 202–3.
- Brock R. The surgical approach to the left atrium: removal of an atrial myxoma. Guys Hosp. Rep. 1956; 105 (4): 382–90.
- Konstantinov B.A., Nechaenko M.A., Kuznetsova L.M., Vinnitski L.I., Sheremet’eva G.F., Khovrin V.V. et al. Clinical, diagnostic and surgical aspects of volumetric heart lesions in children and adolescents. Surgery. 2007; 4: 4–8 (in Russ.).
- Jones D.R., Warden H.E., Murray G.F., Hill R.C., Graeber G.M., Cruzzavala J.L. et al. Biatrial approach to cardiac myxomas: a 30-year clinical experience. Ann. Thorac. Surg. 1995; 59 (4): 851–6. DOI: 10.1016/0003-4975(95)00064-r
- Rammos St K. Modified biatrial approach for the surgical excision of left atrial myxomas. Ann. Thorac. Surg. 1997; 64 (1): 274–5. DOI: 10.1016/s0003-4975(97)00479-7
- Yüksel A., Saba D., Veliogˇ lu Y., Ener S., Özkan H. Biatrial approach provides better outcomes in the surgical treatment of cardiac myxomas. Braz. J. Cardiovasc. Surg. 2016; 31 (4): 309–17. DOI:10.5935/1678-9741.20160066
- Stevens L.M., Lapierre H., Pellerin M., El-Hamamsy I., Bouchard D., Carrier M. et al. Atrial versus biatrial approaches for cardiac myxomas. Interact. Cardiovasc. Thorac. Surg. 2003; 2 (4): 521–5. DOI: 10.1016/S1569- 9293(03)00135-X
- Hatemi A.C., Gürsoy M., Tongut A., Kilic,kesmez K., Karaogˇ lu, S., Küc,ükogˇ lu E. et al. Left atriotomy versus right atriotomy trans-septal approach for left atrial myxoma. J. Int. Med. Res. 2010; 38 (1): 276–81. DOI: 10.1177/147323001003800132
- Guiraudon G.M., Ofiesh J.G., Kaushik R. Extended vertical transatrial septal approach to the mitral valve. Ann. Thorac. Surg. 1991; 52: 1058–60.
- Kumar N., Saad E., Prabhakar G., De Vol E., Duran C.M. Extended transseptal versus conventional left atriotomy: early postoperative study. Ann. Thorac. Surg. 1995; 60 (2): 426–30. DOI: 10.1016/0003-4975(95)00449-u
- Siminelakis S., Kakourou A., Batistatou A., Sismanidis S., Ntoulia A, Tsakiridis K. et al. Thirteen years follow-up of heart myxoma operated patients: what is the appropriate surgical technique? J. Thorac. Dis. 2014; 6 (S1): S32–8. DOI: 10.3978/j.issn.2072-1439.2013.10.21
- Sawaki S., Ito T., Maekawa A., Hoshino S., Hayashi Y., Yanagisawa J. et al. Outcomes of video-assisted minimally invasive approach through right mini-thoracotomy for resection of benign cardiac masses; compared with median sternotomy. Gen. Thorac. Cardiovasc. Surg. 2015; 63 (3): 142–6. DOI: 10.1007/s11748-014-0456-0
- Bianchi G., Margaryan R., Kallushi E., Giuseppe A.C., Farneti P.A., Pucci A. et al. Outcomes of video-assisted minimally invasive cardiac myxoma resection. Heart Lung Circ. 2019; 28 (2): 327–33. DOI: 10.1016/j.hlc.2017.11.010
- Mandryk Y., Czesla M., Massoudy P. Atrial myxoma: minimally invasive surgical approach and application of cryoablation to prevent recurrence. Interact. Cardiovasc. Thorac. Surg. 2018; 27 (4): 609–10. DOI: 10.1093/icvts/ivy080
- Spadaccio C., Elkasrawy K., Sutherland F.W.H. New minimally invasive surgical approach for excision of left atrial myxoma. Gen. Thorac. Cardiovasc. Surg. 2017; 65 (10): 605–8. DOI: 10.1007/s11748-017-0779-8
- Schröder C., Leukhardt W.H., Hsiao E.M., Farah M.G., Markowitz A.H. Transaortic video-assisted resection of a recurrent left ventricular myxoma. Ann. Thorac. Surg. 2013; 95 (1): 340–2. DOI: 10.1016/j.athoracsur.2012.04.144
- Lysenko A.V., Stonogin A.V., Axelrod B.A., Bazarov D.V., Fedulova S.V., Yudichev I.I., Semenyakin I.V. Robo-assisted rexection of left atrial myxoma (the first clinical case). Clinical and Experimental Surgery. Petrovsky Journal. 2019; 7 (4): 95–7 (in Russ.). DOI: 10.24411/2308-1198-2019-14013
- Jiang C.X., Wang J.G., Qi R.D., Wang W., Gao L.J., Zhao J.H. et al. Long-term outcome of patients with atrial myxoma after surgical intervention. J. Geriatr. Cardiol. 2019; 16 (4): 338–43. DOI: 10.11909/j.issn.1671-5411.2019.04.003
- Pérez-Riera A.R., de Abreu L.C., Barbosa-Barros R., Grindler J., Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Ind. Pacing Electrophysiol. J. 2016; 16 (4): 126–33. DOI: 10.1016/j.ipej.2016.10.002
- Sahin M., Tigen K., Dundar C., Ozben B., Alici G., Demir S. et al. Postoperative atrial fibrillation in patients with left atrial myxoma. Cardiovasc. J. Afr. 2015; 26: 120–4. DOI: 10.5830/CVJA-2014-069
- Ha J.W., Kang W.C., Chung N., Chang B.C., Rim S.J., Kwonet J.W. et al. Echocardiographic and morphologic characteristics of left atrial myxoma and their relation to systemic embolism. Am. J. Cardiol. 1999; 83 (11): 1579–A8. DOI: 10.1016/s0002-9149(99)00156-3
- Dias R.R., Fernandes F., Ramires F.J., Mady C., Albuquerque C.P., Jatene F.B. et al. Mortality and embolic potential of cardiac tumors. Arq. Bras. Cardiol. 2014; 103 (1): 13–8. DOI: 10.5935/abc.20140096
- Shah I.K., Dearani J.A., Daly R.C., Suri R.M., Park S.J., Joyce L.D. et al. Cardiac myxomas: A 50-year experience with resection and analysis of risk factors for recurrence. Ann. Thorac. Surg. 2015; 100 (2): 495–500. DOI: 10.1016/j.athoracsur.2015.03.007
- Keeling I.M., Oberwalder P., Anelli-Monti M., Schuchlenz H., Demel U., Tilz G.P. et al. Cardiac myxomas: 24 years of experience in 49 patients. Eur. J. Cardiothorac. Surg. 2002; 22 (6): 971–7. DOI: 10.1016/s1010-7940(02)00592-4
About the authors
- Tel’man A. Simonyan, Postgraduate, ORCID
- Leo A. Bockeria, Academician of RAS and RAMS, President, ORCID
- Ivan I. Skopin, Dr. Med. Sc., Professor, Head of Department, Director of Institute for Coronary and Vascular Surgery, ORCID
