Atrial mucus is a cancer of the heart, a benign tumor that is detected more often in women than in men. We talk to prof. Jerzy Sadowski, from the Clinical Department of Heart Surgery, Vascular Surgery and Transplantology at the Krakow Specialist Hospital. John Paul II in Krakow.
- Professor, what is atrial myxoma?
Atrial lymphomas are the most common heart cancers. These are benign tumors which, due to non-specific symptoms, may prove difficult to diagnose. About 75% of myxomas are found in women.
- Which age group does it most often apply to?
The case reports in the literature cover patients of all ages, from 3 to 83 years old. The mean age of diagnosis is 30-50 years for the so-called sporadic, while for family cases, because they also occur, the average age of diagnosis is 25 years.
- I must admit that I haven't heard much about heart cancer, how often do we even talk about them? Are there any statistics to tell about the scale?
The incidence of atrial myxoma in one of the studies from Ireland, carried out in 1977-1991, was 0.50 atrial myxoma per million population per year. This means that within two years, one person in a million will become ill, which is a rather rare disease. Based on data from 22 large US autopsy studies, we know that the prevalence of primary heart tumors is approximately 0.02% (200 tumors per million autopsies). About 75% of the primary heart tumors are benign and 50% of them are myxomas. In other words, out of a million postmortem examinations, 75 people have had myxoma. Lymphomas account for about 40-50% of all primary heart tumors. About 90% of them appear singly, they are pedunculated and in 75-85% we find them in the cavity of the left atrium, and only 25% are located in the right atrium.
- What are the causes of myxoma?
Most cases of myxoma occur sporadically and the etiology remains unknown. However, there are known family cases, such as Carney's syndrome, which probably accounts for around 7% of myxoma cases.
- Some people say that people after cardiac and cardiac surgeries are more at risk?
Yesthere was really no relationship between myxoma and previous cardiac surgery or interventional cardiology surgery.
- Is myxoma difficult to diagnose?
Getting the diagnosis right may prove to be more difficult than you might expect. The greatest difficulty is the inclusion of myxoma in the differential diagnosis when the patient presents non-specific symptoms (such as fatigue, arrhythmias, palpitations, fainting). However, if we think about the possibility of myxoma and refer the patient for an appropriate examination, the diagnosis can be made almost immediately.
- How is this diagnosis done?
The primary diagnostic method is echocardiography. It is worth mentioning, however, that in about 20% of patients, myxoma may be asymptomatic and become a random find when examinations are performed for a different reason. Either way, myxoma is treated as a cardiac emergency.
- What are the treatment methods for this condition?
The only method of treating myxoma is its surgical excision. The operation is performed by median sternotomy (cutting the sternum) and in extracorporeal circulation (using an artificial heart-lung machine). This is an open-heart surgery. The modern approach includes minimally invasive procedures such as small lateral thoracotomy. The mucus does not require any subsequent chemotherapy.
Prof. Jerzy Sadowski
- What is the effectiveness of such operations? Are patients after rehabilitation able to return to full fitness?
Surgical treatment is the treatment of choice and is safe and effective - it usually allows for permanent cure. Early postoperative mortality is about 2%, and many centers treat the diagnosis of myxoma as an emergency, requiring urgent surgical intervention. Relapses most often result from incomplete tumor excision. Rehabilitation does not differ from that performed after other cardiosurgical procedures, and patients return to full fitness.
In one study, which assessed the long-term prognosis of 62 patients after atrial myxoma surgery, after 10 years, almost 97% of patients were still alive - the prognosis is very good, provided that cardiac surgery is performed at the appropriate stage of the disease. Relapses are rare - in the mentioned group only in 2 patients with familial myxoma (which means 97% freedom from reoperation after 10 years).
- Can the myxoma have any effect on the damage orcorrect operation of valves?
Structural damage to the valves by neoplasms usually does not occur, but the risk stems from the fact that the tumor is usually pedunculated, and thus mobile. In echocardiographic images, we often see a tumor balloting into the left ventricle through the mitral valve. A large mass of the tumor may be associated with occlusion of the atrioventricular orifice and give symptoms of valvular disease, with the correct structure of the valve. Another problem is peripheral congestion, which may arise when tearing off pieces of myxoma. Either way - the tumor needs to be removed. Sudden cardiac death can occur in up to 15% of patients with atrial myxoma. The cause of death is typically coronary or systemic embolism, or obstruction of blood flow through the mitral or tricuspid valve.
- Referring to the previous question - is it true that during the removal of the tumor it may be necessary to implant an artificial valve?
Cardio-oncological surgery requires complete removal of the neoplastic lesion. This can cause such extensive damage to the heart structures that it is necessary to prosthetize, e.g. with an artificial valve. Such cases, however, are quite rare.
The article was written on the occasion of the New Frontiers in Interventional Cardiology (NFIC) workshop in Krakow.