Objective To summarize the clinical characteristics and surgical treatment experience of 1 106 patients with cardiac myxoma. Methods Clinical data of 1 106 patients with cardiac myxoma who underwent surgical treatment in Beijing Anzhen Hospital from 2002 to 2018 were retrospectively analyzed. There were 749 (67.7%) females and 357 (32.3%) males. Results The highest incidence rate was at the age of 51-70 years. The location of the disease was: left atrium in 987 (89.2%) patients, right atrium in 99 (9.0%) patients, left ventricle in 10 (0.9%) patients, right ventricle in 8 (0.7%) patients. There were 1 013 patients of heart classification (NYHA) Ⅰ-Ⅱ and 93 patients of Ⅲ-Ⅳ. There were 301 patients with cerebral infarction and 57 patients with peripheral arterial embolism. Tumor size was closely related to hemodynamic symptoms (P≤0.05), but not to peripheral vascular embolism (P>0.05). Two (0.2%) patients died in hospital and 306 patients were followed up, with a follow-up rate of 27.7%. The median follow-up time was 7 years (range, 1-18 years). One patient died of all causes, and 23 patients recurred, with a recurrence rate of 2.1%. Among 23 recurrent patients, 15 (65.2%) patients were atypical myxoma and 8 (34.8%) patients were typical myxoma. There was no statistical difference in aortic clamping time, ICU stay time, ventilator-assisted breathing time, postoperative hospital stay time, postoperative mortality, or cardiac ejection fraction at discharge between the reoperation in 23 recurrent patients and the first operation in 1 083 non-recurrentpatients. Conclusion Cardiac myxoma is more common in middle-aged and elderly women, and it often occurs in the left atrium. The size of cardiac myxoma can affect the hemodynamic changes. Surgical treatment is effective. Atypical myxoma is more common in recurrent patients, and the effect is still satisfactory through surgical treatment.
Carney complex (CNC) is a rare autosomal dominant syndrome, characterized by pigmented lesions of the skin and mucosa, cardiac, cutaneous and other myxomas and multiple endocrine tumors. The disease is caused by inactivating mutations or large deletions of the PRKAR1A gene located at 17q22–24 coding for the regulatory subunit type Ⅰ alpha of protein kinase A (PKA) gene. Most recently, components of the complex have been associated with defects of other PKA subunits, such as the catalytic subunits PRKACA (adrenal hyperplasia) and PRKACB (pigmented spots, myxomas, pituitary adenomas). We reviewed CNC’s clinical features, diagnosis, treatment and molecular etiology.
ObjectiveTo investigate the clinical manifestations of patients with cardiac myxoma and the factors affecting the occurrence of embolic events. Methods A retrospective study of 38 patients with cardiac myxoma diagnosed and surgically removed from January 2010 to December 2017 was performed. There were 11 males and 27 females at age of 32-75 (50.00±16.12) years. The patients were divided into a non-embolized group and an embolized group. The clinical manifestations of the patients were summarized and the factors leading to embolism were analyzed. RseultsOf the 26 patients in the non-embolized group, 22 patients (84.62%) had dyspnea, 14 patients (53.85%) had palpitations, 4 patients (15.38%) had angina pectoris, and 1 patient (3.85%) had heart failure. Of the 12 patients in the embolized group, 4 patients (33.33%) had dyspnea, 3 patients (25%) had palpitations, and 1 patient (8.33%) had angina pectoris. The mean diameter of the non-embolized group was 5.71±1.63 cm, and the maximum diameter of the tumor in the embolized group was 4.52±1.88 cm. There was no significant difference between the maximum diameter of the tumor in the embolized group and the maximum diameter of the non-embolized group (P>0.05). Atrial fibrillation occurred in 2 patients in the non-embolized group before operation. Atrial fibrillation occurred in 5 patients in the embolized group. Atrial fibrillation was more likely to occur in the embolized group (P<0.05). Conclusion Atrial fibrillation in the patients with cardiac myxoma is closely related to embolic events. The size of myxoma is not related to the occurrence of embolic events.
Objective To explore the diagnosis accuracy of cardiac tumor and effectiveness of surgical treatment. Method We retrospectively analyzed the clinical data of 103 patients with cardiac tumor in our hospital from 2011 through 2014 year. There were 65 females and 38 males, aging from 3 months to 82 years (average age of 59.71±13.80 years). We analyzed age distribution and clinical manifestation of the patients, as well as size and location of tumors. Then we compared effects of different surgical procedures. Result There was no death during evaluation. Early postoperative complications included arrhythmia (47 patients), electrolyte disturbance (13 patients), and cardiac dysfunction (9 patients). One patient with B-cell non-Hodgkin's lymphoma auto-discharged because of cardiac dysfunction. No relapse was obse-rved in the patients with atrial myxoma or lipoma (2 patients) during follow-up. One patient with benign myogenic tumor was lost during the follow-up. Six patients with malignant tumor were with poor long-term effect including 2 patients lost in the follow-up and 4 deaths due to tumor relapse during 1 year after surgery. Conclusion Surgery is still the most effective and major therapy of cardiac tumor.
ObjectiveTo investigate clinical outcomes and safety of minimally invasive left atrial myxoma (LAM) resection via right anterolateral minithoracotomy (ALMT). MethodsClinical data of 9 patients who underwent minimally invasive LAM resection via right ALMT in the Affiliated Hospital of Luzhou Medical College from January 2011 to October 2013 were retrospectively analyzed. There were 2 male and 7 female patients with their age of 37-62 (51±9) years. The operation was performed through a small (4-6 cm) right ALMT incision. Femoral artery and vein and superior vein were cannulated to establish cardiopulmonary bypass (CPB). Transthoracic clamp was used for ascending aortic clamping. Antegrade cold blood cardioplegia was infused for myocardial protection. LAM was resected through right atriotomy trans-septal approach. ResultsAll the operations were successfully performed without in-hospital death. Operation time was 210-310(260±33) minutes, aortic cross-clamping time was 23-50(37±9) minutes, CPB time was 60-87(71±9) minutes, postoperative mechanical ventilation time was 6-14(9.0±2.5) hours, and length of ICU stay was 17-26(20±3) hours. Postoperative mediastinum drainage was 100-650(376±190) ml. Mean length of right ALMT was 4.5-6.0 (5.3±0.6) cm. All the patients were followed up for 1 to 30 months,and echocardiography showed no LAM recurrence. ConclusionMinimally invasive LAM resection via right ALMT is safe and feasible with satisfactory clinical outcomes.