Right atrial trans-septal approach for left atrial myxomas--nine-year experience.
OBJECTIVE
In this single-center study we reviewed our experience with left atrial myxomas occurring over the past 9 years.


METHODS
Sixty-three patients underwent excision of cardiac myxomas between 1995 and 2004. Of these, 56 patients (32 females and 24 males) had left atrial (LA) myxoma. The mean age was 37.80+12.97 years (range 3.5-67 years). Echocardiography was the only diagnostic evaluation done. The preferred approach for resection was right atrial trans-septal. Annual echocardiographic evaluation was undertaken following surgery. Follow-up is current and available in all the survivors (range 4 months-9 years).


RESULTS
Clinically 75% of the LA myxomas simulated mitral stenosis. The symptoms were present for 2-6 months before operation. Most (86%) LA myxomas were attached to the fossa ovalis. Few (14%) originated from the LA wall, mitral valve annulus and anterior mitral leaflet. One patient succumbed to low cardiac output and another died of massive embolic stroke following surgery. There were no late deaths. Two patients (3.7%) developed left hemiparesis after operation but recovered completely. There was one (1.9%) recurrence 3 years after surgery. Atrial fibrillation occurred in one patient. Mitral insufficiency which was seen in two (3.7%) patients prior to surgery subsided following excision of the tumor. Postoperatively 94% patients remained without symptoms.


CONCLUSIONS
Owing to the risk of valvular obstruction or embolization early surgery is indicated. Right atrial trans-septal approach is safe and easy. Most patients are asymptomatic following surgery. A yearly follow-up is essential.
PK Sen Department of Cardiovascular & Thoracic Surgery, KEM Hospital, Parel, Mumbai 400 012, India. vslad@rediffmail.com
V S
VS
Lad
J
J
Jain
S
S
Agarwala
V K
VK
Sinha
J V
JV
Khandekar
N B
NB
Agrawal
J M S
JM
Khandeparkar
Anil
A
Patwardhan
D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006338:Heart Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000601:surgery*; D012189:Retrospective Studies