The surgical treatment of atrial myxomas. Clinical experience and late results in 33 patients.

Thirty-three patients (28 female and five male) from 17 to 70 years of age (mean age 48 years) underwent excision of left atrial myxomas between 1957 and 1981 at The Cleveland Clinic Foundation. Twenty-four patients presented with congestive heart failure, three with tachyarrhythmias, two with syncope, and one each with angina, peripheral embolization, hemoptysis, and recurrent pleural effusions. Symptoms were present from 1 to 72 months before operation (mean 11.2 months). Thirty-one tumors originated from the atrial septum and two from the mitral valve anulus. Twenty-nine tumors were pedunculated, and four were sessile; they weighed from 20 to 112 gm (mean 57 gm). No right atrial or ventricular tumors were identified. The myxomas were successfully removed in all patients, either by shaving them from the atrial septum (n = 17) or by excising a portion of normal atrial septum with the tumor (n = 16). One death (3.0%) occurred 8 days after operation as a result of multiple tumor emboli to the coronary circulation. Follow-up is current and complete in all cases (range 1 to 25 years, mean 6.7 years). Twenty-eight patients are in New York Heart Association Class I, and the remaining four patients are in Class II. No recurrent myxomas have been identified clinically or by echocardiography in any patient. Altogether, 24 patients have been studied by two-dimensional echocardiography up to 20 years after operation (mean 4.0 years). In this series, excellent results were obtained by simple excision of the tumor, with or without a margin of normal atrial septum. Long-term clinical and echocardiographic follow-up is recommended since late recurrence, although rare, has been reported.