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Cardiac Myxoma: Fourteen-Year Experience of a Tertiary Reference Center

Yıl 2017, Cilt: 20 Sayı: 3, 210 - 216, 03.12.2017

Öz

Introduction:
Myxoma
is the most common primary cardiac tumor, which is frequently diagnosed between
the ages of 30-60 years. Myxomas are encountered more frequently in women. They
are mostly located in the left atrium. In this retrospective study, we observed
demographic, clinical, pathological, and echocardiographic findings of myxomas.
In addition to short and long term follow-up result of patients having myxoma,
we researched the risk factors of patients who presented with embolism as a
complication of myxoma. Also we researched the risk factors of the patients who
represented with embolism.



Patients
and Methods:
In this retrospective study, we searched the database of
our hospital using the keyword “myxoma” between March 2001 and January 2015.
Sixty-six patients, whose cardiac tumors were resected and confirmed as myxoma
after pathologic evaluation, were included in this study.



Results: The mean
age of our surgically treated patients was 55 ± 12.3 years. Forty (% 60.6) of
them were female, and the most common presented symptom was dyspnea. An embolic
event was noted in %19.7 of patients. Myxomas were mostly located in the left
atrium. A total of 4 (%6) patients showed tumor recurrence, and only one patient
died during the follow-up. As the patients were compared regarding embolic
phenomenon, male gender, location at the roof of the left atrium, and irregular
surface characteristics were more frequently associated with embolism.



Conclusion: Contrary to previous
studies, in our study, thromboembolic events as an important complication of
myxomas was associated with male gender and location at the roof of the left
atrium. However, in accordance with other studies, type 1 myxomas were
significantly more prevalent in our patients with the diagnosis of embolism.

Kaynakça

  • 1. Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T. Cardiac tumours: diagnosis and management. Lancet Oncol 2005;6:219-28.
  • 2. Leja MJ, Shah DJ, Reardon MJ. Primary Cardiac Tumors. Tex Heart Inst J 2011;38: 261-2.
  • 3. 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.
  • 4. Castillo JG, Silvay G. Characterization and management of cardiac tumors. Semin Cardiothorac Vasc Anesth 2010;14:6-20.
  • 5. Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine 2001;80:159-72.
  • 6. Vroomen M, Houthuizen P, Khamooshian A, Soliman Hamad MA, van Straten AH. Long-term follow-up of 82 patients after surgical excision of atrial myxomas. Interact Cardiovasc Thorac Surg 2015 Aug;21:183-8.
  • 7. Keeling IM, Oberwalder P, Anelli-Monti M, Schuchlenz H, Demel U, Tilz GP, et al. Cardiac myxomas: 24 years of experience in 49 patients. Eur J Cardiothorac Surg 2002;22:971-7.
  • 8. Obrenovic-Kircanski B, Mikic A, Parapid B, Djukic P, Kanjuh V, Milic N, et al. A 30-year-single-center experience in atrial myxomas: from presentation to treatment and prognosis. Thorac Cardiovasc Surg 2013;61:530-6.
  • 9. Vijan V, Vupputuri A, Nair RC. An unusual case of biatrial myxoma in a young female. Case Rep Cardiol 2016:1-3.
  • 10. Yuan SM. Glandular cardiac myxoma: case report with literature review. Folia Morphol 2014;73:374-82.
  • 11. Dell’amore A, Albertini A, Lamarra M. Twenty years experience in oncologic surgery for primary cardiac tumors. G Chir 2013;34:106-11.
  • 12. Patil NP, Dutta N, Satyarthy S, Geelani MA, Kumar Satsangi D, Banerjee A. Cardiac myxomas: experience over one decade. J Card Surg 2011; 26:355-9.
  • 13. Swartz MF, Lutz CJ, Chandan VS, Landas S, Fink GW. Atrial myxomas: pathologic types, tumor location, and presenting symptoms. J Card Surg 2006;21:435-40.
  • 14. Vaideeswar P, Gupta R, Mishra P, Lanjewar C, Raut A. Atypical cardiac myxomas: a clinicopathologic analysis and their comparison to 64 typical myxomas. Cardiovasc Pathol 2012;21:180-7.
  • 15. Zheng Z, Guo G, Xu L, Lei L, Wei X, Pan Y. Left atrial myxoma with versus without cerebral embolism: length of symptoms, morphologic characteristics, and outcomes. Tex Heart Inst J 2014;41:592-5.
  • 16. Reynen K. Cardiac myxomas. N Engl J Med 1995;333:1610-7.
  • 17. Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, et al. Embolic potential of cardiac tumors and outcome after resection: a casecontrol study. Stroke 2009;40:156-62.
  • 18. Kuon E, Kreplin M, Weiss W, Dahm JB. The challenge presented by right atrial myxoma. Herz 2004;29:702-9.
  • 19. Panos A, Kalangos A, Sztajzel J. Left atrial myxoma presenting with myocardial infarction. Case report and review of the literature. Int J Cardiol 1997;62:73-5.
  • 20. Vogt PR, Jenni R, Turina MI. Infected left atrial myxoma with concomitant mitral valve endocarditis. Eur J Cardiothorac Surg 1996;10:71-3.
  • 21. Riad MG, Parks JD, Murphy PB, Thangathurai D. Infected atrial myxoma presenting with septic shock. J Cardiothorac Vasc Anest 2005;19:508-11.
  • 22. Sheng WB, Luo BE, Liu Y, Zhang H, Zou LJ, Xu ZY, et al. Risk factors for postoperative recurrence of cardiac myxoma and the clinical managements: a report of 5 cases in one center and review of literature. Chin Med J 2012;125:2914-8.
  • 23. Acebo E, Val-Bernal JF, Gomez-Roman JJ, Revuelta JM. Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience. Chest 2003;123:1379-85.
  • 24. Kalkan ME, Acar G, Şahin M, Taş MH, Demir S, Yanartaş M, et al. Mean platelet volume levels in patients with cardiac myxoma. Platelets 2014; 25:587-91.
  • 25. He DK, Zhang YF, Liang Y, Ye Sx, Wang C, Kang B, et al. Risk factors for embolism in cardiac myxoma: a retrospective analysis. Med Sci Monit 2015;21:1146-54.
  • 26. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patane F, La Torre M, et al. Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Ann Thorac Surg 1999;68:1236-41.
  • 27. Perek B, Misterski M, Stefaniak S, Ligowski M, Puslecki M, Jemielity M. Early and long-term outcome of surgery for cardiac myxoma: experience of a single cardiac surgical centre. Kardiol Pol 2011;69:558-64.
  • 28. Arıcı B, Taşar M, Özçınar E, Ada F, İnan MB, Eryılmaz S, et al. Kardiyak miksomalar ve cerrahi sonuçları. Turk Gogus Kalp Dama 2015;23:473-7.
  • 29. Porapakkham P, Porapakkham P, Petchyungtong P. Cardiac myxoma: sixteen-year experience in Central Chest Institute of Thailand. J Med Assoc Thai 2012;95:1509-16.
  • 30. Hall RJ, Cooley DA, McAllister HA, Frazier OH, Wilansky S. Neoplastic heart disease. In: Fuster V, Alexander RW, O’Rourke RA (eds). Hurst’s the heart. 10th ed. New York: McGraw-Hill, 2001:2179-95.
  • 31. 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.
  • 32. 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(Suppl 1):S32-8.
  • 33. Owers CE, Vaughan P, Braidley PC, Wilkinson GA, Locke TJ, Cooper GJ, et al. Atrial myxomas: a single unit’s experience in the modern era. Heart Surg Forum 2011;14:E105-9.
  • 34. Kajihara N, Tanoue Y, Eto M, Tomita Y, Masuda M, Morita S. Surgical experience of cardiac tumors: early and late results. Surg Today 2006;36:602-7.
  • 35. Kuroczynski W, Peivandi AA, Ewald P, Pruefer D, Heinemann M, Vahl CF. Cardiac myxomas: short- and long-term follow-up. Cardiol J 2009;16:447-54.
  • 36. Lone RA, Ahanger AG, Singh S, Mehmood W, Shabir Shah S, Lone G, et al. Atrial myxoma: trends in management. Int J Health Sci (Qassim) 2008;2:141-51.
  • 37. Kothari J, Lakhia K, Solanki P, Panchal J, Shah P. Recurrent left atrial myxoma in a young patient: a rare entity. J Clin Diagn Res 2016;10:PD05-7.
  • 38. van Gelder HM, O’Brien DJ, Staples ED, Alexander JA. Familial cardiac myxoma. Ann Thorac Surg 1992;53:419-24.
  • 39. Ipek G, Erentug V, Bozbuga N, Polat A, Guler M, Kirali K, et al. Surgical management of cardiac myxoma. J Card Surg 2005;20:300-4.
  • 40. Kapısız NS, Kapısız HF, Doğan OV, Yücel E. Recurrent familial cardiac myxomas in a mother and daughter with Carney’s syndrome. Turk Gogus Kalp Dama 2009;17:40-2.
  • 41. Lee SJ, Kim JH, Na CY, Oh SS. Eleven years’ experience with Korean cardiac myxoma patients: focus on embolic complications. Cerebrovasc Dis 2012;33:471-9.
  • 42. Lee VH, Connolly HM, Brown RD Jr. Central nervous system manifestations of cardiac myxoma. Arch Neurol 2007;64:1115-20.
  • 43. Sabatine MS, Colucci WS, Schoen FJ. Primary tumors of the heart. In: Zipes DP, Libby P, Braunwald E (eds). Braunwald’s heart disease. 7th ed. Philadelphia: Elsevier, 2005:1741-55.

Kardiyak Miksoma: Tersiyer Bir Referans Merkezinin 14 Yıllık Deneyimi

Yıl 2017, Cilt: 20 Sayı: 3, 210 - 216, 03.12.2017

Öz

Giriş: Miksomalar sıklıkla 30 ile 60 yaş aralığında tanı alan en sık görülen
primer kardiyak tümörlerdir. Miksomalar kadınlarda daha sık görülür. En sık
olarak sol atriyum yerleşimlidirler. Biz retrospektif tek merkezli bu
çalışmamızda miksomaların demografik, klinik, patolojik ve ekokardiyografik
özellikler ile birlikte kısa ve uzun dönem sonuçlarını sunduk. Ayrıca emboli
kliniği ile başvuran miksoma hastalarındaki risk faktörlerini araştırdık.



Hastalar ve
Yöntem:
Retrospektif tanımlayıcı nitelikteki bu araştırmada
üçüncü basamak eğitim ve araştırma hastanemizin veritabanında cerrahi
epikrizleri Mart 2001-Ocak 2015 tarih aralığında ‘‘miksoma’’ anahtar kelimesi
ile tarandı. Cerrahi olarak rezeke edilmiş ve patolojik olarak kesin tanısı konmuş
olan 66 hasta çalışmamıza dahil edildi.



Bulgular: Miksoma tanısıyla elektif cerrahi uygulanan hastalarımızın ortalama yaşları
55 ± 12.3 yıl idi. Kırk (%60.6) hasta kadın cinsiyetindeydi. En sık görülen
semptom dispneydi. Hastaların %19.7’sinde geçirilmiş bir emboli atağı mevcuttu.
Miksomalar en sık sol atriyumdan köken almaktaydı. Takip süresince 4 (%6)
hastada nüks, sadece bir hastada ölüm görüldü. Emboli geçiren ve geçirmeyen
gruplar kıyaslandığında emboli geçiren grupta erkek cinsiyet, sol atriyum çatısında
yerleşim ve irregüler yüzey istatistiksel anlamlı olarak daha fazla saptandı.



Sonuç: Bizim çalışmamızda,
miksomaların önemli bir komplikasyonu olan embolik olaylar, önceki
çalışmalardan farklı olarak erkek cinsiyet ve sol atriyum çatısından köken alan
miksomalar ile ilişkili bulunmuştur.  Tip
1 miksomalar da diğer çalışmalar ile benzer şekilde emboli tanısı olan
hastalarımızda anlamlı derecede daha fazla saptanmıştır.

Kaynakça

  • 1. Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T. Cardiac tumours: diagnosis and management. Lancet Oncol 2005;6:219-28.
  • 2. Leja MJ, Shah DJ, Reardon MJ. Primary Cardiac Tumors. Tex Heart Inst J 2011;38: 261-2.
  • 3. 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.
  • 4. Castillo JG, Silvay G. Characterization and management of cardiac tumors. Semin Cardiothorac Vasc Anesth 2010;14:6-20.
  • 5. Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine 2001;80:159-72.
  • 6. Vroomen M, Houthuizen P, Khamooshian A, Soliman Hamad MA, van Straten AH. Long-term follow-up of 82 patients after surgical excision of atrial myxomas. Interact Cardiovasc Thorac Surg 2015 Aug;21:183-8.
  • 7. Keeling IM, Oberwalder P, Anelli-Monti M, Schuchlenz H, Demel U, Tilz GP, et al. Cardiac myxomas: 24 years of experience in 49 patients. Eur J Cardiothorac Surg 2002;22:971-7.
  • 8. Obrenovic-Kircanski B, Mikic A, Parapid B, Djukic P, Kanjuh V, Milic N, et al. A 30-year-single-center experience in atrial myxomas: from presentation to treatment and prognosis. Thorac Cardiovasc Surg 2013;61:530-6.
  • 9. Vijan V, Vupputuri A, Nair RC. An unusual case of biatrial myxoma in a young female. Case Rep Cardiol 2016:1-3.
  • 10. Yuan SM. Glandular cardiac myxoma: case report with literature review. Folia Morphol 2014;73:374-82.
  • 11. Dell’amore A, Albertini A, Lamarra M. Twenty years experience in oncologic surgery for primary cardiac tumors. G Chir 2013;34:106-11.
  • 12. Patil NP, Dutta N, Satyarthy S, Geelani MA, Kumar Satsangi D, Banerjee A. Cardiac myxomas: experience over one decade. J Card Surg 2011; 26:355-9.
  • 13. Swartz MF, Lutz CJ, Chandan VS, Landas S, Fink GW. Atrial myxomas: pathologic types, tumor location, and presenting symptoms. J Card Surg 2006;21:435-40.
  • 14. Vaideeswar P, Gupta R, Mishra P, Lanjewar C, Raut A. Atypical cardiac myxomas: a clinicopathologic analysis and their comparison to 64 typical myxomas. Cardiovasc Pathol 2012;21:180-7.
  • 15. Zheng Z, Guo G, Xu L, Lei L, Wei X, Pan Y. Left atrial myxoma with versus without cerebral embolism: length of symptoms, morphologic characteristics, and outcomes. Tex Heart Inst J 2014;41:592-5.
  • 16. Reynen K. Cardiac myxomas. N Engl J Med 1995;333:1610-7.
  • 17. Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, et al. Embolic potential of cardiac tumors and outcome after resection: a casecontrol study. Stroke 2009;40:156-62.
  • 18. Kuon E, Kreplin M, Weiss W, Dahm JB. The challenge presented by right atrial myxoma. Herz 2004;29:702-9.
  • 19. Panos A, Kalangos A, Sztajzel J. Left atrial myxoma presenting with myocardial infarction. Case report and review of the literature. Int J Cardiol 1997;62:73-5.
  • 20. Vogt PR, Jenni R, Turina MI. Infected left atrial myxoma with concomitant mitral valve endocarditis. Eur J Cardiothorac Surg 1996;10:71-3.
  • 21. Riad MG, Parks JD, Murphy PB, Thangathurai D. Infected atrial myxoma presenting with septic shock. J Cardiothorac Vasc Anest 2005;19:508-11.
  • 22. Sheng WB, Luo BE, Liu Y, Zhang H, Zou LJ, Xu ZY, et al. Risk factors for postoperative recurrence of cardiac myxoma and the clinical managements: a report of 5 cases in one center and review of literature. Chin Med J 2012;125:2914-8.
  • 23. Acebo E, Val-Bernal JF, Gomez-Roman JJ, Revuelta JM. Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience. Chest 2003;123:1379-85.
  • 24. Kalkan ME, Acar G, Şahin M, Taş MH, Demir S, Yanartaş M, et al. Mean platelet volume levels in patients with cardiac myxoma. Platelets 2014; 25:587-91.
  • 25. He DK, Zhang YF, Liang Y, Ye Sx, Wang C, Kang B, et al. Risk factors for embolism in cardiac myxoma: a retrospective analysis. Med Sci Monit 2015;21:1146-54.
  • 26. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patane F, La Torre M, et al. Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Ann Thorac Surg 1999;68:1236-41.
  • 27. Perek B, Misterski M, Stefaniak S, Ligowski M, Puslecki M, Jemielity M. Early and long-term outcome of surgery for cardiac myxoma: experience of a single cardiac surgical centre. Kardiol Pol 2011;69:558-64.
  • 28. Arıcı B, Taşar M, Özçınar E, Ada F, İnan MB, Eryılmaz S, et al. Kardiyak miksomalar ve cerrahi sonuçları. Turk Gogus Kalp Dama 2015;23:473-7.
  • 29. Porapakkham P, Porapakkham P, Petchyungtong P. Cardiac myxoma: sixteen-year experience in Central Chest Institute of Thailand. J Med Assoc Thai 2012;95:1509-16.
  • 30. Hall RJ, Cooley DA, McAllister HA, Frazier OH, Wilansky S. Neoplastic heart disease. In: Fuster V, Alexander RW, O’Rourke RA (eds). Hurst’s the heart. 10th ed. New York: McGraw-Hill, 2001:2179-95.
  • 31. 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.
  • 32. 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(Suppl 1):S32-8.
  • 33. Owers CE, Vaughan P, Braidley PC, Wilkinson GA, Locke TJ, Cooper GJ, et al. Atrial myxomas: a single unit’s experience in the modern era. Heart Surg Forum 2011;14:E105-9.
  • 34. Kajihara N, Tanoue Y, Eto M, Tomita Y, Masuda M, Morita S. Surgical experience of cardiac tumors: early and late results. Surg Today 2006;36:602-7.
  • 35. Kuroczynski W, Peivandi AA, Ewald P, Pruefer D, Heinemann M, Vahl CF. Cardiac myxomas: short- and long-term follow-up. Cardiol J 2009;16:447-54.
  • 36. Lone RA, Ahanger AG, Singh S, Mehmood W, Shabir Shah S, Lone G, et al. Atrial myxoma: trends in management. Int J Health Sci (Qassim) 2008;2:141-51.
  • 37. Kothari J, Lakhia K, Solanki P, Panchal J, Shah P. Recurrent left atrial myxoma in a young patient: a rare entity. J Clin Diagn Res 2016;10:PD05-7.
  • 38. van Gelder HM, O’Brien DJ, Staples ED, Alexander JA. Familial cardiac myxoma. Ann Thorac Surg 1992;53:419-24.
  • 39. Ipek G, Erentug V, Bozbuga N, Polat A, Guler M, Kirali K, et al. Surgical management of cardiac myxoma. J Card Surg 2005;20:300-4.
  • 40. Kapısız NS, Kapısız HF, Doğan OV, Yücel E. Recurrent familial cardiac myxomas in a mother and daughter with Carney’s syndrome. Turk Gogus Kalp Dama 2009;17:40-2.
  • 41. Lee SJ, Kim JH, Na CY, Oh SS. Eleven years’ experience with Korean cardiac myxoma patients: focus on embolic complications. Cerebrovasc Dis 2012;33:471-9.
  • 42. Lee VH, Connolly HM, Brown RD Jr. Central nervous system manifestations of cardiac myxoma. Arch Neurol 2007;64:1115-20.
  • 43. Sabatine MS, Colucci WS, Schoen FJ. Primary tumors of the heart. In: Zipes DP, Libby P, Braunwald E (eds). Braunwald’s heart disease. 7th ed. Philadelphia: Elsevier, 2005:1741-55.
Toplam 43 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Yiğit Çanga

Mehmet Baran Karataş Bu kişi benim

Ali Nazmi Çalık Bu kişi benim

Tahir Bezgin Bu kişi benim

Veysel Ozan Tanık Bu kişi benim

Ufuk Yıldız Bu kişi benim

Emir Renda Bu kişi benim

Tolga Sinan Güvenç Bu kişi benim

Can Yücel Karabay Bu kişi benim

Ömer Kozan Bu kişi benim

Yayımlanma Tarihi 3 Aralık 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 20 Sayı: 3

Kaynak Göster

Vancouver Çanga Y, Karataş MB, Çalık AN, Bezgin T, Tanık VO, Yıldız U, Renda E, Güvenç TS, Karabay CY, Kozan Ö. Kardiyak Miksoma: Tersiyer Bir Referans Merkezinin 14 Yıllık Deneyimi. Koşuyolu Heart Journal. 2017;20(3):210-6.