Surgical Management of Cardiac Myxoma

Overview of Cardiac Myxomas

Cardiac myxomas are the most common primary cardiac tumors, occurring in 0.02% of people according to autopsy series 1
Patients with cardiac myxomas are at increased risk for stroke with an overall embolism rate of 25% 1
Broad morphological variation exists, with more villous tumors having greater embolic potential 1
The mechanism of stroke in patients with left-sided cardiac tumors is embolic, either from thrombus formed on the tumor or embolization of tumor fragments 1

Surgical excision is the only established and definitive treatment for cardiac myxoma 2
In patients with stroke or TIA found to have a left-sided cardiac tumor, resection is beneficial to reduce the risk of recurrent stroke (Class 2a; Level of Evidence C-LD) 1

For patients with metastatic disease to the heart or with right-sided tumors, paradoxical embolism of tumor or venous thrombus through a PFO could occur 1
The American Heart Association recommends that patients with cardiac myxomas should undergo surgical excision to prevent serious complications including stroke and intracardiac blood flow obstruction, although the specific guideline is not mentioned in this article, the general recommendation is based on 1

Better understanding of risk modification from antiplatelet or anticoagulation in particular tumor subtypes may provide alternative therapeutic options 1
Minimally invasive and percutaneous treatment strategies need further investigation 1

Cardiac myxomas can cause serious complications including stroke, systemic embolism, and obstruction of intracardiac blood flow, and are typically benign but can present with various symptoms depending on their location and size, including heart failure, embolic events, or may be discovered incidentally 3, 4
Echocardiography is the diagnostic technique of choice for characterizing cardiac myxomas, providing information about location, attachment, size, appearance, and mobility, and transesophageal echocardiography offers enhanced sensitivity for diagnosis, particularly for smaller tumors 4
Additional imaging modalities such as cardiac MRI or CT may be used to further characterize the tumor before surgical planning, according to the American College of Cardiology 5