Cardiac myxomas in patients over 75 years of age: A series of 19 cases

Left atrial myxoma is considered to be exceptionally rare in the elderly: T he authors observed and reported on 19 cases occurring in patients over 75 years of age out of a series of 100 myxomas diagnosed between 1962 and 1997 , in 12 women and 7 men (mean age : 80 years, range 75 to 89 years). In 3 cases, the myxomas were chance findings at echocardiography but the 16 symptomatic patients (85%) had left ventricular failure (47%), positional symptoms (25%), pyrexia and poor general health (17%) or systemic embolism (17%). The location of the myxoma was the left atrium in all cases, with mitral va lve obstruction in 13 of the 19 cases. Eighteen tumours were attached to th e interatrial septum and one to the atrial surface of the anterior mitral l eaflet. Calcifications were observed in 5 patients. Surgical ablation of the tumour was performed in 15 of the 19 patients. The postoperative course was usually uncomplicated : one patient died of a cer ebral haemorrhage. Four patients did not undergo surgery because of patient refusal in 3 cases and major associated morbidity in the other case. These cases were included in the study because the tumours had all the character istics of myxomas. Though the discovery of a myxoma remains a classical surgical emergency, th e presence of quiescent, non-obstructive, well circumscribed and calcified myxomas with a low risk of obstruction and of embolism in elderly high risk patients may be exceptions to this traditional dogma.