Surgical management of right atrial myxomas. A 15 year experience with review of the literature.
BACKGROUND
A retrospective study to evaluate the clinical symptoms, signs, investigations, surgical technique and follow-up of an uncommon cardiac tumour.


METHODS
Experimental design and setting: this retrospective study was carried out in a tertiary care hospital in South India on patients treated from 1981 to 1996. Duration of follow-up has been for a maximum period of 9.5 years.


METHODS
all patients who were diagnosed to have right atrial myxoma were included in this study. There were seven patients (4 males, 3 females) with ages ranging from 16 to 52 years.


METHODS
six of these patients underwent complete excision. One patient who presented with SVC obstruction had locally invasive tumour and only a biopsy was done. In order to reduce the risk of intraoperative pulmonary embolism in the last two cases, we crossclamped the pulmonary artery as soon as cardiopulmonary bypass was initiated.


RESULTS
There was one postoperative death due to refractory right ventricular failure (14.3%). Four patients have been followed-up for a mean of 40.7 months. All of them are free of recurrence and most of them are asymptomatic.


CONCLUSIONS
Right atrial myxoma is a rare usually benign cardiac tumor whose definitive diagnosis is made on the basis of 2D echocardiography. The crucial aspects of surgery are measures for prevention of intraoperative embolism, en-bloc excision of the tumour with a wide cuff of normal tissue and inspection of all four chambers in order to avoid missing tumour emboli or an occasional multicentric lesion. Patients with myxomatous emboli into the pulmonary artery require simultaneous pulmonary embolectomy.
Selvaraj
A
A
Department of Cardiothoracic Surgery, Christian Medical College & Hospital, Vellore, South India.
Kumar
R
R
Ravikumar
E
E
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass; D005260:Female; D006325:Heart Atria; D006338:Heart Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome