title: Risk factors for postoperative recurrence of cardiac myxoma and the clinical managements: a report of 5 cases in one center and review of literature.
abstract: BACKGROUND
  Recurrence or metastasis of myxomas is not rare and can lead to malignancy. We aimed to analyze the risk factors for postoperative cardiac myxoma recurrence and to summarize its clinical characteristics, treatments and classification.
  
  
  METHODS
  The clinical data of 5 patients with recurrent cardiac myxoma were retrospectively analyzed and our clinical experience was summarized. Moreover, the relevant literatures were reviewed.
  
  
  RESULTS
  All the five cases of primary myxomas were derived from atypical positions. One patient had early distant metastasis, one had family history, and two suffered malignant recurrence. The recurrence interval was (2.30 ± 2.16) years and the recurrent tumors were all found in different chambers from those of the corresponding primary tumors. Re-operation was performed after recurrence. One patient died of heart failure after malignant recurrence, and the other 4 cases had satisfactory therapeutic outcomes after re-operations. Our experience advocated a clinical classification of "typical" and "atypical" cardiac myxoma, the typical myxomas referred to the tumors locating at the left atria, with single pedicle, rooted at or around the fossa ovalis, involving no genetic causes, and the atypical myxomas included the familial tumors, tumors stemming from multiple chambers, rooted in abnormal positions of the left atrium, with evident genetic mutation, or with malignant tendency.
  
  
  CONCLUSIONS
  Postoperative follow-up is of vital importance for patients with myxomas characterized by multi-chamber distribution, early distant metastasis, atypical origin, and family history. Once recurs, re-operation is necessary and should be performed immediately.
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Wen-Bo
authors.initials: WB
authors.lastname: Sheng
authors.forename: Bei-Er
authors.initials: BE
authors.lastname: Luo
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Liang-Jian
authors.initials: LJ
authors.lastname: Zou
authors.forename: Zhi-Yun
authors.initials: ZY
authors.lastname: Xu
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Zhang
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Ji
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors