What are cardiac myxomas?

From the Guidelines

Cardiac myxomas are benign primary cardiac tumors, most commonly found in the left atrium, which can embolize and cause ischemic stroke, making surgical excision a recommended treatment. These tumors are typically characterized by their gelatinous, mucus-like tissue composition, consisting of primitive connective tissue cells embedded in a mucopolysaccharide matrix 1. They often appear as pedunculated masses attached to the heart wall by a stalk, allowing them to move within the heart chamber. According to the guidelines for the primary prevention of stroke, myxomas are the most common cardiac tumor, with about 30% to 40% of them embolizing, posing a significant risk for embolic stroke 1.

Key characteristics of cardiac myxomas include:

• Most common type of primary cardiac tumor
• Typically benign growths
• Frequently located in the left atrium
• Composed of gelatinous, mucus-like tissue
• Can cause symptoms such as heart valve obstruction, embolism, or heart failure
• Diagnosis often involves echocardiography, cardiac MRI, or CT scans
• Surgical removal is the standard treatment, usually curative with a good prognosis 1.

It is essential to note that while myxomas are generally benign, their potential to embolize and cause serious complications, such as ischemic stroke, necessitates prompt surgical intervention, as recommended by the American Heart Association/American Stroke Association 1.

From the Research

Definition and Characteristics of Cardiac Myxomas

• Cardiac myxomas are the most common primary tumors of the heart, with the majority being benign 2, 3, 4, 5, 6.
• They are typically located in the left atrium, but can also occur in the right atrium or ventricles 2, 3, 4, 5, 6.
• Cardiac myxomas can produce symptoms caused by the release of inflammatory cytokines, obstruction to intracardiac blood flow, and/or embolization 2, 3, 4, 5, 6.

Clinical Presentation and Diagnosis

• Patients with cardiac myxomas can exhibit a variety of clinical manifestations, including systemic-constitutional, embolic, cardiac, and secondary metastatic manifestations 3, 5, 6.
• A classic triad for cardiac myxomas involves constitutional, embolic, and obstructive or cardiac symptoms 5, 6.
• Imaging modalities such as echocardiography, CT scan, and cardiac MRI can help diagnose cardiac myxomas, with echocardiogram being the first-line imaging technique 3, 4, 5, 6.
• Definitive diagnosis requires macroscopic and histopathological assessment, including positivity for endothelial cell markers such as CD31 and CD34 6.

Management and Prognosis

• Surgical excision is the established definitive treatment for cardiac myxomas, carrying a low operative risk and giving excellent short-term and long-term results 2, 3, 4, 5, 6.
• Prompt surgical resection is necessary to prevent complications such as embolic events or obstruction of the mitral orifice 3, 4, 5, 6.
• The prognosis for patients with cardiac myxomas is excellent when treated with prompt surgical resection, with postsurgical survival rates analogous to overall survival in the age-matched general population 2, 3, 6.