What is the treatment for cardiac myxoma?

Surgical Resection is the Definitive Treatment for Cardiac Myxoma

Surgical excision is the only effective treatment for cardiac myxoma and should be performed promptly after diagnosis to prevent potentially life-threatening complications such as embolism, obstruction of blood flow, and sudden death. 1, 2

Understanding Cardiac Myxomas

• Cardiac myxomas are the most common primary cardiac tumors, occurring predominantly in the left atrium (78%), though they can develop in any cardiac chamber 2
• These tumors are typically benign but can cause serious complications including stroke, systemic embolism, and obstruction of intracardiac blood flow 1, 3
• Myxomas can present with various symptoms depending on their location and size, including heart failure, embolic events, or may be discovered incidentally 3

Diagnostic Approach

• Echocardiography is the diagnostic technique of choice for characterizing cardiac myxomas, providing information about location, attachment, size, appearance, and mobility 3
• Transesophageal echocardiography offers enhanced sensitivity for diagnosis, particularly for smaller tumors 3
• Additional imaging modalities such as cardiac MRI or CT may be used to further characterize the tumor before surgical planning 3

Treatment Recommendations

Primary Treatment: Surgical Resection

• Surgical excision is the only effective treatment for cardiac myxoma as there is no effective medical therapy 1, 2
• Surgery should be performed promptly after diagnosis due to the risk of sudden death, embolism, and intracardiac obstruction 4
• The procedure typically involves:
  • Complete resection of the tumor along with its attachment site (pedicle) to prevent recurrence 2
  • Use of cardiopulmonary bypass 1
  • Careful inspection of all cardiac chambers to ensure no additional tumors are present 5

Surgical Approaches

• Traditional median sternotomy is the standard approach used in 97.5% of cases 5
• Alternative approaches include:
  • Minimally invasive techniques (such as right mini-thoracotomy) which may offer shorter ICU stays and reduced blood loss in selected patients 6
  • Robotic-assisted surgery, which shows potential as a safe alternative but has limitations including higher costs 6

Specific Surgical Considerations

• The transseptal surgical approach is preferred (78% of cases) for left atrial myxomas as it allows complete resection of the tumor along with its pedicle, reducing recurrence risk 2
• For right ventricular myxomas, especially those obstructing both inflow and outflow tracts, emergency surgical excision may be necessary 4
• Additional cardiac procedures may be required depending on tumor location and extent 5

Postoperative Management

• Routine postoperative echocardiographic monitoring is essential to detect any residual or recurrent tumors 6
• Long-term follow-up is recommended, though recurrence after complete surgical excision is extremely rare 1, 2

Outcomes and Prognosis

• Surgical treatment of myxomas is relatively safe with mortality rates comparable to other types of cardiac surgery (approximately 3.6%) 5
• Most patients have an excellent prognosis after surgery 1
• Postoperative complications occur in approximately 12% of cases 5
• No recurrence has been reported in many case series with proper surgical technique 2

Special Considerations

• In patients with familial forms of myxoma (such as Carney complex), more extensive follow-up may be warranted due to higher recurrence risk 2
• For patients with hemodynamic instability due to cardiac myxoma, urgent surgery is indicated 5

Surgical excision remains the gold standard treatment for cardiac myxoma, with excellent outcomes when performed by experienced surgical teams. Complete resection with removal of the attachment site is crucial to prevent recurrence.