Surgical considerations in the treatment of cardiac myxoma.

Misinterpretation of confusing cardiac, constitutional, and embolic symptoms delayed the diagnosis of cardiac myxoma and caused two of 18 patients to undergo acute operations during cardiogenic shock with pulmonary edema. In recent cases echocardiographic screening of unclear cardiac symptoms gave the correct diagnosis early. Despite the simple surgical procedure (excision of tumor and underlying endocardium), the postoperative course was complicated by cardiac failure, arrhythmias, and systemic reactions. Prosthetic valve thrombosis and malignancy caused two early deaths. Two patients died later of cerebrovascular insults. Both belonged to a group of five patients having preoperative emboli from fragile myxomas. Four of these five had coronary or cerebral myxomatous pseudoaneurysms. A 6 year follow-up, including recatheterization, showed no tumor recurrence and generally normalization of the clinical condition, heart size, and catheterization findings. Even pronounced mitral insufficiency accompanying left atrial myxomas had subsided spontaneously. Tricuspid insufficiency in two patients with right atrial myxomas persisted, necessitating reoperation in one. When diagnosed, a cardiac myxoma should be removed promptly to reduce cardiac and embolic complications, including myxomatous pseudoaneurysm formation, which might be more frequent than previously recognized.