ATRIAL MYXOMAS - EXPERIENCES WITH 35 PATIENTS IN HAWAII

BACKGROUND: Thirty-five patients with an intracardiac myxoma underwent excision of the tumor in Hawaii between 1974 and 1993. PATIENTS AND M ETHODS: There were 28 female and 7 male patients in the group, Their a ges ranged from 11 to 79 years (mean 48) with the majority (71%) betwe en 30 and 60 years old, The patients' medical records were reviewed an d special attention was paid to clinical presentation, methods of diag nosis, operative findings, and postoperative course, RESULTS: No ethni c predisposition was found, Forty-six percent of the presenting sympto ms were cardiac (congestive heart failure 26%, palpitations 14%, and s yncope 6%) while arterial embolization accounted for 11%, Diagnosis wa s made by angiography, echocardiography, or gated cardiac blood pool i maging, Ah were reliable, but two-dimensional (2-D) echocardiography w as used most often, with no false-positive or false-negative results. There were 32 left atrial, 2 right atrial, and 1 biatrial myxomas, Lim ited septectomy was performed in most cases, but 9 patients (26%) requ ired Dacron patch repair of the atrial septum, There was 1 death from a cerebrovascular accident the day after the removal of a left-sided a trial myxoma, Other patients had few minor postoperative complications , One patient presented with a recurrence 8 years after resection at a nother institution; no further recurrences were found. CONCLUSIONS: We conclude that due to the nonspecific presentation of atrial myxoma, a high index of suspicion is needed, The diagnostic method of choice is 2-D echocardiography, Limited septectomy is a safe procedure, but clo se follow-up for at least 10 years may be needed to rule out recurrenc e.