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      Surgical resection of cardiac myxoma—a 30-year single institutional experience

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          Abstract

          Background

          Primary cardiac tumors are rare and myxoma constitutes the majority. The present study summarizes our 30-year clinical outcomes of surgical myxoma resection.

          Methods

          Between January 1986 and December 2015, 93 patients (30 men, 63 women; mean age, 54.7 ± 16.6 years) underwent surgical myxoma resection. The most common origin site was the left atrium. Surgery was performed via a biatrial approach in 74.2%, atrial septotomy through right atriotomy in 17.2%, and left atriotomy only in 8.6%. Mean myxoma size based on longest length was 4.73 ± 1.92 cm (range, 1.2–11.0 cm).

          Results

          The mean follow-up duration was 9.9 ± 7.8 years (range, 0–29 years). In-hospital mortality was 3.2%. The most common postoperative complication was atrial fibrillation (4.3%). The 5-, 10-, and 30-year survival rates were 92.9%, 87.2%, and 75.5%, respectively. Recurrence occurred in two patients (2.1%), which were detected at 20 and 79 months after the first surgery, respectively.

          Conclusions

          Long-term survival after myxoma resection was excellent and recurrence was rare. Based on our experience, surgical method did not affect the outcome.

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          Most cited references15

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          Primary cardiac tumors: early and late results of surgical treatment in 91 patients.

          Between March 1980 and September 1997, 91 patients underwent evaluation and treatment for primary cardiac neoplasms. Tumors were grouped into three categories: atrial myxomas, benign nonmyxomas, and malignant tumors. Survivors were contacted; no one was lost to follow-up. The mean follow-up for this series is 7 +/- 5 years. Eighty-three patients were diagnosed with atrial myxomas (Male/Female: 29/54), average age 55 +/- 13 years. The hospital mortality was 3.6% (3/83), the late mortality was 6.5% (5/80). No recurrent myxomas have been identified clinically or by echocardiography in any patient. Three patients were diagnosed with benign nonmyxoma tumors. (Male/Female: 2/1), average age 64 +/- 8 years. There were no perioperative deaths and 1 patient died 4 years postoperatively from fibroma, with no linked causes. No recurrent tumors have been identified. Five patients were diagnosed with malignant tumors. (M/F: 1/4), average age 53 +/- 16 years. The hospital mortality was 20% (1/5); in 3 patients a redo-operation was necessary after 8, 11, and 12 months because of tumor recurrence. All patients died within 3 years of the first operation (mean 13 +/- 14 months). Surgical resection, when possible, is the treatment of choice for all primary cardiac tumors. Patients with benign tumors are probably cured by resection and in our experience there was no known tumor recurrence. Effective palliation is possible with resection of malignant tumors, but more effective adjuvant therapy will be necessary to improve long-term prognosis.
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            Surgical excision of cardiac myxomas: twenty years experience at a single institution.

            Primary cardiac tumors are quite uncommon and myxomas constitute the major proportion among these masses. The present study summarizes our 20-year clinical experience with surgical resection of intracardiac myxomas. Between January 1990 and December 2007, 98 patients (42 males, mean age 60.4±4.1 years) underwent complete excision of primary intracardiac myxoma. In 84 patients the origin site of the tumor was located in the left atrium, and the most common implant site was the interatrial septum. The most common symptom at admission was dyspnea, while systemic embolization was observed in 37 patients. Preoperative diagnosis was established in all patients by transthoracic echocardiography. All patients were operated through median sternotomy. Ninety-five patients (97%) survived the operation. Mean tumor dimension was 2.7±1.3 cm in largest diameter. According to the St. John Sutton classification (St. John Sutton MG, Mercier LA, Giuliani ER, et al. Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Pro 1980;55:371-6), solid tumors were detected in 43 patients (44%), while a papillary myxoma was found in 55 patients (56%). The follow-up was 100% complete, and the mean time to last follow-up was 98±60 months. Of the 95 survivors, 3 patients (3%) died at a mean follow-up of 72±45 months after surgery. Actuarial survival was 98%, 98%, and 89% at 5, 10, and 15 years, respectively. One patient operated for left atrial myxoma resection showed a recurrence 68 months after the first surgery. Although cardiac myxomas carry the risk of severe systemic and cardiac symptoms, prompt surgical excision gives excellent early and long-term results. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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              Cardiac myxoma: 40 years' experience in 63 patients.

              Cardiac myxomas were resected in 63 patients, including the first successful procedure in the world. Patient data and data obtained during follow-up of the survivors were reviewed. Preoperatively, valve obstruction occurred in 56% and emboli in 32% of the patients. The myxomas were located in the left atrium in 88%, right atrium in 10%, and both atria in 1 patient (1.6%). One patient died early, and 5 died late. The 20-year survival rate was 85%. At a median of 13 years (range, 1 month to 42 years) after resection, 26% of the survivors reported having various cardiopulmonary symptoms, 5% had had thromboembolic events, and 69% were asymptomatic. After 2 years, there was a recurrence in a young woman who had had a multifocal myxoma at the time of the primary operation. No other evidence of recurrence was found at autopsy or during repeat echocardiography in the remaining patients during an observation period of 787 patient-years. Surgical resection of a single myxoma is a safe and effective treatment, with a low risk of recurrence. After uncomplicated resection, the frequency with which postoperative echocardiography is performed should be limited.
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                Author and article information

                Contributors
                waytogosun@naver.com
                lovingmylife@naver.com
                yochun@medimail.co.kr
                isjeong1201@gmail.com
                kjna1125@hanmail.net
                bsoh@chonnam.ac.kr
                bhahn@chonnam.ac.kr
                82-62-220-6546 , waytogosun@gmail.com
                Journal
                J Cardiothorac Surg
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central (London )
                1749-8090
                27 March 2017
                27 March 2017
                2017
                : 12
                : 18
                Affiliations
                Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42, Jebong-ro, Dong-gu, Gwangju, 15772 South Korea
                Article
                583
                10.1186/s13019-017-0583-7
                5368917
                28347356
                84bf3cf9-aa43-4ca9-94cd-d8080e40c326
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 October 2016
                : 21 March 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Surgery
                myxoma,benign cardiac tumor
                Surgery
                myxoma, benign cardiac tumor

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