CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
AFRICA
311
artery bypass surgery was performed in a patient with coronary
artery disease (Table 1).
The minimum follow-up period was 12 months and the
maximum was 132 months (median, 60 months). One of the
patients with myxoma died in the early postoperative period due
to cerebrovascular accident.
In some of the cases, pleural effusion was detected with
computed tomography and chest X-ray (Fig. 3). We used abdom-
inal and peripheral Doppler ultrasound in case 12, and found a
subacute thrombus which totally obstructed the abdominal aorta,
extending 3 cm in the proximal part down to the bifurcation and
including 4 cm proximally in the common femoral artery. The
details of the cases are presented in Table 1.
Discussion
Cardiac myxomas most commonly occur in the third to fourth
decade of life, and approximately 75% of sporadic myxomas
occur in females.
2
They frequently occur in the left atrium in
75% of cases. The right atrium is involved in 15 to 20% of cases.
There is no difference in terms of frequency of involvement of
the ventricles (6–8%).
2
There were 10 female (83%) and two
(17%) male patients. In addition, left atrial involvement was
observed in 67% of the cases in our study, in accordance with
the current literature.
Cardiac myxomas originate from primitive, multipotential
mesenchymal cells present in the heart wall as embryonic
remnants. Histopathologically, a myxoma is composed of an
abundant acid mucopolysaccharide matrix in which polygonal
cells and immature endothelial cells forming blood vessels are
embedded in chronic inflammation.
5,7,8
Masses from the 12 cases
in our study were histopathologically typical of myxomas.
Myxomas cause peripheral embolisms, in which fragments of
the tumour break away into the blood stream and cause clots or
blockages. Systemic embolism is encountered in 30 to 45% of
myxoma cases.
9-11
A massive embolism can cause death. There
were two cases with femoral artery embolism in our series,
which were confirmed on pathological evaluation. Fortunately,
in our series, no patient had a cerebral embolism, which may
have been fatal.
On the other hand, aneurysms may also occur in these
patients, causing symptoms associated with central nervous
system involvement.
12
Therefore a careful examination for any
symptom that could possibly be associated with nervous system
involvement should be an essential part of the therapeutic
approach.
An important aspect of our study was that the tumour
was detected in all patients by echocardiography, which was
performed due to the non-specific symptoms of the patients.
Coronary angiography, however, was performed in older
patients who were thought to have coronary artery disease.
Echocardiographic follow up was done on a routine basis in
the third, sixth and twelfth months and thereafter annually in all
patients. We feel that routine echocardiographic follow up may
help in earlier diagnosis and timely intervention to avoid neuro-
logical sequelae.
Operative resection of the myxomas is the treatment of
choice. Some authors believe that resection should be performed
immediately after the diagnosis is made.
2-4
We performed our
operations immediately after the diagnosis.
Conclusion
The development of diagnostic techniques and the routine
practice of echocardiography have enabled us to define cardiac
tumours earlier, important for both the initial diagnosis and for
detecting a recurrence. Hence, mortality and morbidity were
Fig. 1. Left atrial mass (4.8
×
7.5 cm) near the interatrial
septum (case 2).
Fig. 2. Excised mass (case 2).
Fig. 3. CT report: 4
×
5-cm hypo-dense lesion (myxoma)
that caused a filling defect in the right atrium.
