Left atrial myxomas: clinical characteristics, evaluation and considerations in classifying tumors
Shimono, T.; Komada, T.; Kusagawa, H.; Shinpo, H.; Yada, I.; Yuasa, H.; Kusagawa, M.; Takeuchi, Y.; Yamazaki, Y.; Takigawa, K.
Nihon Kyobu Geka Gakkai 40(7): 1060-1066
1992
ISSN/ISBN: 0369-4739 PMID: 1506697 Document Number: 392429
Eleven patients underwent surgical excision for left atrial myxomas. Clinical symptoms, coronary angiographic findings and operative procedures were evaluated. Myxomas were classified into two types based on macroscopical findings, and clinical characteristics of these two types were analyzed. Seven cases (64%) classified as "lobular-type myxomas" were seen as lobulated, gelatinous and fragile. Four cases (36%) were classified as "round-type myxomas" were seen as lobulated, gelatinous and fragile. Four cases (36%) were classified as "round-type myxomas" were round and elastic soft. Primary symptoms included dyspnea on exertion in five cases (45%) and neurological disturbances in six cases (55%). Brain emboli were found in four patients by CT scan, and were classified as lobular-type myxomas. These eleven myxomas successfully removed in all cases. Four of these myxomas, which were pedunculated with fine fibrous stalks, were shaved along the base at the atrial septum or freewall. Others were excised completely along with a portion of the adjacent septum. Microscopic examination of the operative specimens revealed that two lobular-type myxomas with broad-based attchment to left atrial septum had invaded the atrial septum. All patients are doing well and have had no signs of myxoma recurrence at postoperative periods ranging from 10 months to 12 years (mean follow-up 5.3 yers). Seven patients underwent selecteive coronary angiography due to a diagnosis of a coronary artery disease. All coronary angiograms were normal in all cases. In five (71%) of these seven, abnormally dilated atrial branches were seen as supplying the tumor. In two cases with round-type myxomas, neovascularity was evident and was made up of clusters of tortuous vessels with tumor blush. We conclude that lobular-type myxomas have a higher risk of tumor embolism and weaker tumor blush with selective coronary angiography when compared with characteristics of round-type myxomas.