Myxoma surgery

Surgery is the mainstay of treatment for cardiac myxoma. The feasibility of surgery depends on the patient hemodynamic stability at diagnosis. Cardiac myxoma surgery has an operative mortality around 0 to 3%, depending on risk factors or mechanical damage to a heart valve, as well as adhesion of the tumor to valve leaflets. The short and long-term prognosis is generally regarded as excellent.

The mainstay treatment for cardiac myxomas is surgical removal. Urgent surgery should be performed because of the possibility of embolic complications or sudden death. Intraoperative fragmentation of the tumor and embolism must be avoided. In most cases, cardiac myxomas can be removed easily because they are sessile or pedunculated.

Surgical intervention is performed as follows:^[1][2][3]

• The tumor is excised with the use of mild general and deep topical hypothermia, cardioplegic cardiac arrest, and cardiopulmonary bypass.
• Median sternotomy
• Removal of myxoma: Cardiac chambers should be inspected to rule out a multifocal tumor.
• Removal of surrounding atrial septum: The root of the pedicle and the full thickness of the adjacent interatrial septum should be excised, resulting in an atrial septal defect.
• Atrial septum defect repair – can be closed by direct suturing or, if too large, with a pericardial or Dacron patch.

The feasibility of surgery depends on the patient hemodynamic stability at diagnosis.^[4]

• Cardiac myxoma surgery has an operative mortality around 0 to 3% depending on risk factors or mechanical damage to a heart valve, as well as adhesion of the tumor to valve leaflets (in some cases, valve repair by annuloplasty or replacement with a prosthetic valve is necessary).^[2]
• The short and long-term prognosis is generally regarded as excellent.

Supraventricular arrhythmias may follow surgical removal of atrial myxomas.^[5]

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