title: Changing management of cardiac myxoma based on a series of 40 cases with long-term follow-up.
abstract: BACKGROUND
  Cardiac myxoma is generally considered to be a surgical emergency. However, as a result of progress in echocardiography and the increasing age of the patients presenting with this disease, the clinical presentation has changed and the management of cardiac myxoma now needs to be reviewed.
  
  
  METHODS
  Between 1978 and 2001, 40 patients (16 men and 24 women) between the ages of 6 months and 82 years (mean age, 55.6 years) were operated on for cardiac myxoma. Signs of heart failure with pulmonary congestion (22%) or pulmonary embolism (20%) indicated a high-risk emergency situation in some cases, whereas, in other cases (58%), the patient's condition was stable and the clinical presentation was less worrying. However, the tumor was always removed within 24 hours of admission. Most cases of cardiac myxoma observed over the last decade correspond to stable forms, as echocardiography has revealed smaller tumors in generally elderly patients.
  
  
  RESULTS
  The postoperative mortality was 7.5% (3 patients). No patients were lost to follow-up, and the mean follow-up was 13.6 years. One patient was reoperated for recurrence 3 years postoperatively. Five patients required further cardiac surgery: three mitral valve replacements, one coronary artery bypass graft, and one angioplasty. The 15-year survival rate was 69%.
  
  
  CONCLUSIONS
  Myxoma tends to be observed in a more elderly and higher risk population, often at an early stage. The classic approach of emergency surgery is not always appropriate in these stable forms, allowing more thorough preoperative assessment of these patients.
authors.affiliation: Hôpital Cardiothoracique, Lyon, France.
authors.forename: Chekir
authors.initials: C
authors.lastname: Selkane
authors.forename: Brahim
authors.initials: B
authors.lastname: Amahzoune
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chavanis
authors.forename: Olivier
authors.initials: O
authors.lastname: Raisky
authors.forename: Jacques
authors.initials: J
authors.lastname: Robin
authors.forename: Jean
authors.initials: J
authors.lastname: Ninet
authors.forename: Jean F
authors.initials: JF
authors.lastname: Obadia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate