What is a cardiac myxoma (a type of benign cardiac tumor)?

From the Guidelines

Myxoma is a rare, benign tumor that typically develops in the heart, most commonly in the left atrium, and is the most common primary cardiac tumor in adults, composed of gelatinous material and varying in size from a few millimeters to several centimeters.

Key Characteristics of Myxoma

• Myxomas are most commonly found in the left atrium, and their symptoms depend on the tumor's location and size, often including shortness of breath, chest pain, fatigue, dizziness, and fainting 1.
• Some patients may experience systemic symptoms like fever, weight loss, and joint pain due to the tumor releasing inflammatory substances.
• Diagnosis typically involves echocardiography, cardiac MRI, or CT scans.

Treatment and Prognosis

• The standard treatment is surgical removal of the tumor, which is generally curative with an excellent prognosis 1.
• However, there is a small risk of recurrence (about 5%), so regular follow-up with cardiac imaging is recommended for several years after surgery.
• Prompt treatment is essential as myxomas can cause serious complications including embolism, heart valve obstruction, or sudden cardiac death if left untreated 1.

Importance of Early Detection and Treatment

• Early detection and treatment of myxoma are crucial to prevent these complications and improve patient outcomes.
• The risk of embolism associated with left atrial tumors is higher, with an odds ratio of 1.95, and even higher (4.17) with aortic valve tumors 1.

From the Research

Definition and Characteristics of Cardiac Myxoma

• Cardiac myxoma is the most common cardiac neoplasm in adults, typically originating in the left atrium 2, 3, 4, 5, 6.
• These tumors are benign but can cause significant local mechanical disturbances and impair cardiac function 2, 3, 6.
• Cardiac myxomas can occur sporadically or as part of a familial condition, notably inherited with autosomal dominance in the Carney complex (approximately 10% of cases) 2, 6.

Clinical Presentation and Complications

• The clinical presentation of cardiac myxomas varies, ranging from asymptomatic cases found incidentally during cardiac echocardiograms performed for unrelated reasons, to severe cardiovascular events such as heart failure, stroke, pulmonary emboli, or sudden death 2, 3, 4, 6.
• Myxomas in the right atrium may rarely embolize to the pulmonary arterial vasculature 4.
• Embolic events and partial or complete obstruction of intracardiac blood flow are potential complications of cardiac myxomas 3, 6.

Diagnosis and Treatment

• Echocardiography is the investigation of choice for diagnosing cardiac myxomas, with echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk being the tell-tale echocardiographic features 6.
• Surgical excision is the mainstay of treatment, with low operative mortality, excellent postoperative survival, and low recurrence rate 3, 5, 6.
• The choice of surgical technique should be individualized by considering the tumor size, location, patient condition, and surgeon expertise 5.