[Cardiac myxoma -- the influence of preoperative clinical presentation and surgical technique on late outcome].
BACKGROUND
Cardiac myxomas are the most frequent primary tumours of the heart in adults, and they can be found in each of four cardiac chambers. Although biologically benign, due to their unfavourable localization, myxomas are considered "functionally malignant" tumours. Diagnosis of cardiac myxoma necessitates surgical treatment.


OBJECTIVE
To analyse: 1) the influence of localization, size and consistency of cardiac myxomas on preoperative symptomatology; 2) the influence of different surgical techniques (left, right, biatrial approach, tumour basis solving) on early, and late outcomes.


METHODS
From 1982 to 2000, at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, there were 46 patients with cardiac myxomas operated on, 67.4% of them women, mean age 47.1 +/- 16.3 years. The diagnosis was made according to clinical presentation, electrocardiographic and echocardiographic examinations and cardiac catheterization. Follow-up period was 4-18 (mean 7.8) years.


RESULTS
In 41 (89.1%) patients, myxoma was localized in the left, while in 5 (10.9%), it was found in the right atrium. Average size was 5.8 x 3.8 cm (range: 1 x l cm to 9 x 8 cm) and 6 x 4 cm (range: 3 x 2 cm to 9 x 5 cm) for the left and right atrial myxomas, respectively. A racemous form predominated in the left (82.6%) and globous in the right (80%) atrium. Fatigue was the most common general (84.8%) and dyspnoea the most common cardiologic symptom (73.9%). Preoperative embolic events were present in 8 patients (4 pulmonary, 4 systemic). In our series: 1) different localization, size and consistency had no influence on the preoperative symptomatology; 2) surgical treatment applied, regardless of different approaches and basis solving, resulted in excellent functional improvements (63.1% patients in NYHA III and IV class preoperatively vs. 6.7% patients postoperatively) and had no influence on new postoperative rhythm disturbances (8.7% patients preoperatively vs. 24.4% patients postoperatively); 3) early (97.8%), and late survival rates (91.3%) were excellent; 4) there were no relapses during the follow-up period.


CONCLUSIONS
Localization, size and consistency had no influence on the preoperative symptomatology. Excellent survival rate with significant functional improvement, rare postoperative complications and no recurrences, justify the applied strategies of surgical approach and tumour basis solving in our series.
Mikić
Aleksandar
A
Obrenović-Krcanski
Bilijana
B
Kocica
Mladen
M
Vranes
Mile
M
Lacković
Vesna
V
Velinović
Milos
M
Miarković
Miroslav
M
Kovacević
Natasa
N
Djukić
Petar
P
D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate