Thirteen years follow-up of heart myxoma operated patients: what is the appropriate surgical technique?

Stavros Siminelakis, Alexandra Kakourou, Alexandra Batistatou, Stelios Sismanidis, Alexandra Ntoulia, Kosmas Tsakiridis, Theodora Syminelaki, Eleftherios Apostolakis, Paul Zarogoulidis, Theodora Tsiouda, Nikolaos Katsikogiannis, Ioanna Kougioumtzi, Georgios Dryllis, Nikolaos Machairiotis, Andreas Mpakas, Thomas Beleveslis, Konstantinos Zarogoulidis

Abstract

Background: Cardiac myxoma is a benign neoplasm that represents the most prevalent primary tumor of the heart. If not treated with the right surgical technique recurrence occurs. Aim of our study is to present our surgical approach and the histology of the tumors resected.
Methods: All patients, except for one, underwent extracorporeal circulation and mild hypothermia, right atrial or both atrial incision and excision of the fossa ovalis, followed by prosthetic patch suturing. All specimens were submitted for microscopic evaluation (haematoxylin-eosin). We contacted personally each patient and asked them to complete a standardized questionnaire, concerning their peri-operative characteristics.
Results: Six cases were “active” myxomas, 3 were “mildly active” and 3 were “inactive”. “Normal differentiation” was seen in 6, “medium” in 1 and “poor” in 5 cases. In our series there were no recurrences recorded during the follow-up period.
Conclusions: The ideal approach, according to our experience is right atrial or both atrial incision as described by Shumacker and King, with excision of the fossa ovalis and the surrounding tissues and closure with a pericardial patch. Such a technique provides an excellent long-term survival in these patients.