Cardiac myxoma

A cardiac myxoma is a type of primary cardiac tumor that is most commonly found in the left atrium of the heart. It is the most prevalent type of primary heart tumor in adults, accounting for approximately 50% of all such tumors. Myxomas are typically benign, meaning they are non-cancerous, but they can cause significant health issues due to their location and potential to obstruct blood flow within the heart.

Pathophysiology

Cardiac myxomas are gelatinous tumors that arise from the endocardium, the inner lining of the heart. They are usually pedunculated, meaning they are attached to the heart wall by a stalk. The most common site for a myxoma is the left atrium, particularly at the border of the fossa ovalis. However, they can also occur in the right atrium and, less commonly, in the ventricles.

The tumor can interfere with normal heart function by obstructing the flow of blood through the heart chambers, particularly during diastole when the heart is relaxed and filling with blood. This obstruction can mimic the symptoms of mitral stenosis, such as shortness of breath, fatigue, and palpitations.

Clinical Presentation

Patients with cardiac myxoma may present with a variety of symptoms, which can be grouped into three categories: obstructive, embolic, and constitutional.

• Obstructive symptoms occur when the tumor blocks blood flow within the heart, leading to symptoms similar to those of heart failure or valvular heart disease.
• Embolic symptoms arise when pieces of the tumor break off and travel through the bloodstream, potentially causing stroke or other embolic events.
• Constitutional symptoms include fever, weight loss, and malaise, which are thought to be due to the release of cytokines by the tumor.

Diagnosis

The diagnosis of a cardiac myxoma is typically made using echocardiography, which can visualize the tumor within the heart. Transesophageal echocardiography provides a more detailed view and is often used to confirm the diagnosis. Other imaging modalities, such as MRI or CT scan, can also be used to assess the size and location of the tumor.

Treatment

The primary treatment for a cardiac myxoma is surgical removal. This is usually performed via open heart surgery, where the tumor is excised along with a small margin of healthy tissue to prevent recurrence. The prognosis after surgical removal is generally excellent, with a low risk of recurrence if the tumor is completely excised.

Prognosis

The prognosis for patients with cardiac myxoma is generally good following surgical removal. Recurrence is rare but can occur, particularly if the tumor is not completely excised. Regular follow-up with echocardiography is recommended to monitor for any signs of recurrence.

Related Pages

• Heart tumor
• Mitral stenosis
• Echocardiography
• Open heart surgery