A RETROSPECTIVE STUDY OF PRIMARY CARDIAC TUMOURS - ANALYSIS OF CLINICAL PRESENTATION, DIAGNOSTIC METHODS,SURGICAL MANAGEMENT, POSTOPERATIVE COMPLICATIONS AND FOLLOW UP RESULTS

Dr.T.Muthuvijayan; Dr.N.Jothilingam

Volume : VII, Issue : XII, December - 2018

A RETROSPECTIVE STUDY OF PRIMARY CARDIAC TUMOURS - ANALYSIS OF CLINICAL PRESENTATION, DIAGNOSTIC METHODS,SURGICAL MANAGEMENT, POSTOPERATIVE COMPLICATIONS AND FOLLOW UP RESULTS

Dr. T. Muthuvijayan, Dr. N. Jothilingam

Abstract :

From July 2014, 44 patients have undergone excision of an intracardiac tumor. All of them were myxomas. The location of the tumors was in left atrium in 40 (90.90%), in the right atrium in 2 (4.5%), and in the right ventricle in 2 (4.5%) patients. Of the 44 patients there were 25(56.8% )female and 19(43.18% ) male patients with a mean age of 46 � 14 years (range, 7 to 68 years). Three patients (6.8%) were asymptomatic; the others were seen mostly with exertional dyspnoea, palpitation, signs of systemic illness, and syncopal episodes.There were no patients with petechial hemorrhages or palpable spleen in this series.Of the 40 patients with myxoma before operation, embolic episodes occurred in 10 patients with a left atrial myxoma. 8 of these patients first manifested with embolic events. Excision of the tumors were done under cardiopulmonary bypass and cold cardioplegic arrest.The left atrial myxomas were approached through right atrium in 26 (65%) patients.Biatrial approach 8(20%) and left atrial approach 6 (15%) were adopted in patients with large myxomas and in myxomas with attachment to sites other than inter atrial septum . For the left atrial myxomas venous cannulation was done by superior and inferior venacaval cannulation through the right atrium.For the right atrial myxoma and right ventricular myxoma the venous cannulation was by direct cannulation of the superior venacava and inferior venacava.During the surgery atmost care was taken to prevent tumor fragmentation and embolization by minimizing the manipulation of the heart. There were two early (4.5%) and two late deaths (4.7%) following the surgery. The survival at 4 yearss is 91% � 4%, and most of the current survivors are asymptomatic at a mean follow-up of 6.5 � 5 years (range, 0.2 year to 4 yearss). Noninvasive reevaluation was performed with echocardiographic studies in 37 patients and ECG in 30 patients. No instances of tumor recurrence were observed, and there was a low incidence of atrial fiillation late postoperatively. We conclude that excision of intracardiac myxomas is curative and long-term survival is excellent. The right atrial approach provides adequate exposure and allows complete removal of the tumor in most of the patients with left atrial myxoma.Other approaches were adopted in left atrial myxomas depending upon the site and size of the tumor