Atrial myxomas: results of 25 years' experience and review of the literature.

Twenty patients with atrial myxoma from a 25-year period were reviewed. Sixteen patients had a tumor in the left atrium, three in the right, and one had a biatrial myxoma. The main clinical presentations were dyspnea and tachyarrhythmias seen in 11 patients. Nineteen patients had a correct preoperative diagnosis. Echocardiography confirmed the diagnosis in eight patients, angiocardiography in four, and both these techniques in seven. The diagnosis was established at the operative table in one case in which the preoperative diagnosis was mitral stenosis. All tumors were successfully removed with cardiopulmonary bypass. There were no operative deaths. Excision of the tumor resulted in marked symptomatic improvement. No recurrences have been observed. A differential approach to preoperative investigation, surgical treatment, and follow-up is suggested according to the clinical behavior of the tumor. Excision of the tumor appears to be curative, with no recurrences at long-term follow-up in cases of "sporadic" myxoma. The risk of recurrences is much higher when a "complex" or a "familial" myxoma is faced. For these types, our recommendations are presented.