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Original Paper

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

Lee S.-J.a · Kim J.-H.b · Na C.-Y.b · Oh S.-S.b

Author affiliations

Departments of aNeurology and bThoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea

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Cerebrovasc Dis 2012;33:471–479

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: June 27, 2011
Accepted: December 12, 2011
Published online: April 19, 2012
Issue release date: May 2012

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background: Cardiac myxomas are rare but are the most common cardiac tumors. This study is based on our clinical experience with cardiac myxomas over a period of 11 years at Sejong General Hospital. We focused on the embolic complications of patients with cardiac myxoma. Methods: We retrospectively reviewed the medical records of 59 consecutive patients with cardiac myxoma who were treated between January 2000 and March 2011. The myxomas were divided into two types: type 1, with an irregular or villous surface and a soft consistency, and type 2, with a smooth surface and a compact consistency. The 59 investigated patients were classified into the embolic group and the non-embolic group. Results: Cardiac obstructive symptoms, embolic events and constitutional symptoms were observed in 37 (62.7%), 13 (22.0%) and 10 (16.9%) patients, respectively. When the embolic and non-embolic groups were compared, there were no significant differences in vascular risk factors, the ejection fraction, the left atrial diameter or the tumor size. However, type 1 myxomas were significantly more frequent in the embolic group (p = 0.009 by Fisher’s exact test). A binary logistic regression analysis showed that type 1 pathology alone was independently associated with myxoma-related embolism (p = 0.008; odds ratio 10.056; 95% confidence interval 1.828–55.337). There were no operative deaths in any of the 59 patients studied. Among the 13 patients with embolism, 11 (84.6%) had brain infarcts. The main patterns of the lesions were multiple lesions (8 out of 11 patients, 72.7%) and lesions in the middle cerebral artery territories (7 out of 11 patients, 63.6%). The other 2 patients were found to have occlusion of the left central retinal artery and left external iliac artery. Additionally, incidental cerebral aneurysms were found in the latter case. There was no recurrence of myxoma or myxoma-related symptoms in the 53 patients receiving outpatient management during the follow-up period (range 2 months to 11 years). Conclusions: The embolic potential of myxoma was associated with an irregular surface pathology but not with vascular risk factors. Echocardiography should be performed in patients with embolic events, especially when cerebral infarcts with multiple territorial lesions are detected. Surgical resection is a relatively safe and curative procedure for cardiac myxoma.

© 2012 S. Karger AG, Basel


References

  1. Blondeau P: Primary cardiac tumors: French studies of 533 cases. Thorac Cardiovasc Surg 1990;38:192–195.
    External Resources
  2. Johansson L: Histogenesis of cardiac myxomas: an immunohistochemical study of 19 cases including one with glandular structures and review of the literature. Arch Pathol Lab Med 1989;113:735–741.
  3. McManus B: Primary tumors of the heart; in Bonow RO, Mann DL, Zipes DP, Libby P (eds): Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, ed 9. Philadelphia, Elsevier Saunders, 2011, pp 1638–1650.
  4. Jourdan M, Bataille R, Sequin J, Zhang XG, Chaptal PA, Klein B: Constitutive production of interleukin-6 and immunologic features in cardiac myxomas. Arthritis Rheum 1990;33:398–402.
  5. Sandok BA, von Estorff I, Giuliani ER: CNS embolism due to atrial myxoma: clinical features and diagnosis. Arch Neurol 1980;37:485–488.
  6. Knepper LE, Biller J, Adams HP Jr, Bruno A: Neurologic manifestations of atrial myxoma. A 12-year experience and review. Stroke 1988;19:1435–1440.
  7. Lee VH, Connolly HM, Brown RD Jr: Central nervous system manifestations of cardiac myxoma. Arch Neurol 2007;64:1115–1120.
    External Resources
  8. Sandok BA, von Estorff I, Giuliani ER: Subsequent neurologic events in patients with atrial myxoma. Ann Neurol 1980;8:305–307.
  9. Roeltgen DP, Weimer GR, Patterson LF: Delayed neurologic complications of left atrial myxoma. Neurology 1981;31:8–13.
  10. St John Sutton MG, Mercier L, Giuliani ER, Lie JT: Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Proc 1980;55:371–376.
  11. Shimono T, Makino S, Kanamori Y, Kinoshita T, Yada I: Left atrial myxomas. Using gross anatomic tumor types to determine clinical features and coronary angiographic findings. Chest 1995;107:674–679.
  12. Pinede L, Duhaut P, Loire R: Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore) 2001;80:159–172.
  13. Acobo E, Val-Bernal JF, Gomez-Roman JJ, Revuelta JM: Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience. Chest 2003;123:1379–1385.
    External Resources
  14. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H: Arterial territories of the human brain: brainstem and cerebellum. Neurology 1996;47:1125–1135.
  15. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H: Arterial territories of the human brain: cerebral hemisphere. Neurology 1998;50:1699–1708.
  16. Wong KS, Gao S, Chan YL, Hansberg T, Lam WW, Droste DW, Kay R, Ringelstein EB: Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol 2002;52:74–81.
  17. Hanson EC, Gill CC, Razavi M, Loop FD: The surgical treatment of atrial myxomas. Clinical experience and late results in 33 patients. J Thorac Cardiovasc Surg 1985;89:298–303.
  18. Bjessmo S, Ivert T: Cardiac myxoma: 40 years’ experience in 63 patients. Ann Thorac Surg 1997;63:697–700.
  19. Larsson S, Lepore V, Kennergren C: Atrial myxomas: results of 25 years’ experience and review of literature. Surgery 1989;105:695–698.
  20. Lukacs L, Lengyel M, Szedo F, Haan A, Nagy L, Thomka I, Kassai I: Surgical treatment of cardiac myxomas: a 20-year follow-up. Cardiovasc Surg 1997;5:225–228.
  21. Carney JA, Gordon H, Carpenter PC, Shoenoy BV, Go VL: The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine 1985;64:270–283.
  22. Farah MG: Familial cardiac myxoma. A study of relatives of patients with myxoma. Chest 1994;105:65–68.
  23. Casey M, Mah C, Merliss AD, Kirschner LS, Taymans SE, Denio AE, Korf B, Irvine AD, Hughes A, Carney JA, Stratakis CA, Basson CT: Identification of a novel genetic locus for familial cardiac myxomas and Carney complex. Circulation 1998;98:2560–2566.
  24. Kumral E: Multiple, multilevel and bihemispheric infarcts; in Bogousslavsky J, Caplan L (eds): Stroke Syndromes, ed 2. New York, Cambridge University Press, 2001, pp 499–511.
  25. Jung JM, Kwon SU, Lee JH, Kang DW: Difference in infarct volume and patterns between cardioembolism and internal carotid artery disease: focus on the degree of cardioembolic risk and carotid stenosis. Cerebrovasc Dis 2010;29:490–496.
  26. Bursztejn AC, Bellut A, Weber-Muller F, Champigneulle J, Beurey P, Cuny JF, Barbaud A, Schmutz JL: Erythematous macules on the feet in a case of cardiac myxoma. Acta Derm Venereol 2009;89:321–322.
    External Resources
  27. Damasio H, Seabra-Gomes R, da Silva JP, Damasio AR, Antunes JL: Multiple cerebral aneurysms and cardiac myxoma. Arch Neurol 1975;32:269–270.
  28. Jean WC, Walski-Easton SM, Nussbaum ES: Multiple intracranial aneurysms as delayed complications of an atrial myxoma: case report. Neurosurgery 2001;49:200–203.
  29. New PF, Price DL, Carter B: Cerebral angiography in cardiac myxoma. Correlation of angiographic and histopathological findings. Radiology 1970;96:335–345.
  30. Furuya K, Sasaki T, Yoshimoto Y, Okada Y, Fujimaki T, Kirino T: Histologically verified cerebral aneurysm formation secondary to embolism from cardiac myxoma. Case report. J Neurosurg 1995;83:170–173.
  31. Sabolek M, Bachus-Banaschak K, Bachus R, Arnold G, Storch A: Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review. Acta Neurol Scand 2005;111:345–350.
  32. Desousa AL, Muller J, Campbell R, Batnitzky S, Rankin L: Atrial myxoma: a review of the neurological complications, metastases, and recurrences. J Neurol Neurosurg Psychiatry 1978;41:1119–1124.
  33. Bernet F, Stulz PM, Carrel TP: Long-term remission after resection, chemotherapy, and irradiation of a metastatic myxoma. Ann Thorac Surg 1998;66:1791–1792.
  34. Rankin LI, Desousa AL: Metastatic atrial myxoma presenting as intracranial mass. Chest 1978;74:451–452.
  35. Engberding R, Daniel WG, Erbel R, Kasper W, Lestuzzi C, Curtius JM, Sutherland GR, Lambertz H, von Hehn A, Lesbre JP: Diagnosis of heart tumours by transesophageal echocardiography: a multicentre study in 154 patients. European Cooperative Study Group. Eur Heart J 1993;14:1223–1228.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: June 27, 2011
Accepted: December 12, 2011
Published online: April 19, 2012
Issue release date: May 2012

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


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