Features of diagnosis and surgical treatment of patients with cardiac myxomas | Ukrainian Medical Journal

In cardiac surgical centers, the frequency of hospitalization of patients with primary cardiac tumors, of which more than 80% are morphologically benign tumors, ranges from 0.09% to 1.9%. Cardiac myxomas (CM) account for about 80% of benign neoplasms of this localization.

The aim of the study: to present the features of diagnosis, clinical course and surgical treatment of CM.

Material and methods. In the Amosov National Institute of Cardiovascular Surgery for the period from 01.01.1969 to 01.01.2025, 1046 patients operated on for primary cardiac tumors. CM detected in 935 (89.4%) patients, of which in 824 (88.1%) cases — CM of the left atrium. Right atrial myxomas detected in 83 (8.9%) cases, left and right ventricles — in 8 (0.9%) cases respectively. Multicentric tumor growth with damage to two or three chambers of the heart detected in 12 (1.3%) patients. The age of patients with СM ranged from 3 to 80 years (average 48.4±3.4 years), of which 677 (72.4%) were aged from 31 to 60 years. Surgical correction of valve lesions performed in 84 (9%) patients: in 18 (1.9%) cases — valve prosthesis, in 66 (7.1%) cases — repair surgery (27 — correction of mitral, 38 — tricuspid, 1 — aortic valves, respectively) with a positive functional effect.

Results. In 339 (36.3%) and 79 (8.5%) patients with CM were classified into functional classes III and IV according to the NYHA classification, respectively. Embolic syndrome detected in patients with CM in 64 (6.8%) cases, relapses observed in 16 (1.7%) patients. Pathology of the valve apparatus in combination with CM noted in 84 (9%) patients. Hospital mortality during surgical treatment of CM in recent 25 years for 576 operations was 0.2% (1 case of pulmonary embolism on the 5th day after surgery).

Conclusions. The variable clinical picture of CM significantly complicates the timely diagnosis of this disease due to the absence of pathognomonic signs of the course of the disease. Echocardiography is the leading diagnostic method that allows referring patients to urgent surgical treatment of this pathology. Over the past 25 years, 576 operations performed for CM with virtually no fatal consequences, which is due to the peculiarities of the tactics of timely diagnosis and emergency surgical treatment, and reduces the frequency of preoperative complications and ensures the radicality of removal of the cardiac neoplasm. The adopted tactics ensure the effectiveness of surgical treatment patients with CM, which confirmed by the data of long-term results: in I functional class according to the NYHA there were 628 (78.3%) patients, in II functional class — 119 (14.8%) patients, respectively; survival within 20 years was 79.7%.

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