title: Cardiac myxomas: 24 years of experience in 49 patients.
abstract: OBJECTIVE
  In this single-center study we reviewed our experience with a significant number of cardiac myxoma cases occurring over the past two decades.
  
  
  METHODS
  Cardiac myxomas represented 86% of all surgically treated cardiac tumors at our center. Specifically, there were 49 consecutive patients, each with at least one myxoma. A detailed clinical, immunological, and echocardiographic long-term examination of 37 patients revealed one recurrent myxoma.
  
  
  RESULTS
  Most myxomas originated from the left atrium (87.7%), but also much less frequently from the mitral valve (6.1%), from the right atrium (4.1%), and from the left and right atria (2.0%). The myxomas produced a prolapse into the left ventricle in 40.8% of the patients, mitral stenosis in 10.2%, and threatened left ventricular outflow tract obstruction in 2.0%. Multiple myxomas were found in 20.4% of the patients. Cardiac signs appeared in 93.9% of the patients. Preoperative embolic events had occurred in 26.5%. Immunologic alterations were present in 87.5%. For resection, a bilateral atriotomy was used. An additional aortotomy was needed to expose one mitral valve myxoma. Postoperatively, 81.1% of the patients remained without cardiac symptoms. The early mortality rate was 2.0% and the late mortality rate was 6.1%. Long-term prognosis was excellent with an actuarial survival rate of 0.74. Specific immunologic alterations were found in 71.4% of the patients. The actuarial freedom from reoperation of the myxoma was 0.96. The rate of reoperations was low with 2.0% after 24 years.
  
  
  CONCLUSIONS
  Myxomas were usually detected and operated on in symptomatic patients. A high index of suspicion seems important for early diagnosis. Immunologic findings may play an additional role in confirming the diagnosis and the recurrence of a myxoma. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Also, a familial genesis must be excluded in myxoma patients.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Karl Franzens University Graz, Graz, Austria. keelingi@medscape.com
authors.forename: I M
authors.initials: IM
authors.lastname: Keeling
authors.forename: P
authors.initials: P
authors.lastname: Oberwalder
authors.forename: M
authors.initials: M
authors.lastname: Anelli-Monti
authors.forename: H
authors.initials: H
authors.lastname: Schuchlenz
authors.forename: U
authors.initials: U
authors.lastname: Demel
authors.forename: G P
authors.initials: GP
authors.lastname: Tilz
authors.forename: P
authors.initials: P
authors.lastname: Rehak
authors.forename: B
authors.initials: B
authors.lastname: Rigler
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006338:Heart Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D009360:Neoplastic Cells, Circulating; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome