RESUMO
Over a ten-year period (September 1980-July 1990) 3172 patients underwent open heart surgery in our hospital. Twenty five patients (0.78%) had a cardiac myxoma. There were 18 female and 7 male patients, mean age of 32.3 +/- 21 years (4-61). Left atrial myxomas were diagnosed in 18 patients, left ventricular myxoma in three, right atrial myxoma in two, and one in right ventricle; there was a biatrial myxoma in one case, another had biatrial and left ventricular myxoma. The clinical manifestations of right sided myxomas was congestive heart failure. Patients with left myxoma frequently presented embolic episodes. Myxoma diagnosis was made by means of chest films, EKG and two-dimensional echocardiography which proved effective in twenty four of our patients; cardiac catheterization was performed in ten of them. Symptoms before diagnosis lasted an average of 16.3 months and mean time from diagnosis to operation was 6.6 days. Different surgical approaches are analyzed and discussed. Concomitant surgical procedures were performed in five patients: mitral annuloplasty in one, mitral valve replacement in four (two biological and two mechanical prosthesis). In eight patients the resulting septal defect due to resection of pedicle was closed with pericardial or dacron patches. There were two operative deaths due to pulmonary emboli in one and multiple organ failure in other. Cardiac myxoma is the more frequent primary neoplasm of the heart; its "benign" nature is doubtful; cure by surgical excision can be considered in vast majority of patients and its morbidity is reasonably low.
Assuntos
Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Fatores Etários , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/epidemiologia , Neoplasias Cardíacas/mortalidade , Ventrículos do Coração/cirurgia , Humanos , Métodos , México/epidemiologia , Mixoma/diagnóstico , Mixoma/epidemiologia , Mixoma/mortalidade , Estudos Retrospectivos , Fatores SexuaisRESUMO
We report five patients with Myxomas of the left atrium studied by catheterization and/or Echocardiography between november 1976 and october 1978. Four patients were operated immediately with extracorporeal circulation which confirmed the diagnosis. The last patient died before surgical intervention due to a severe hepatorenal syndrome and extensive pulmonary infection. Another patient died postoperatively on the second day due to irreversible pulmonary hypertensión. The remaining three patients are asymptomatic (average 28 months after surgery). Reviewing the diagnostic methods, particularly the Echocardiogram, we found that it is a good diagnostic tool, making catheterization with the risks of myxomatous embolization unnecessary. Furthermore, the Echo facilitates simple and economic observation for the detection of relapses. Finally, broad and careful surgical management most be emphasized in order to avoid transoperative emboli, tumoral dissemination, and latent relapses, mediated by the greater use of filters and a broad resection of the implantation pedicule.