Myxoma natural history: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, cardiac myxoma progression occurs slowly. The overlap of various phenomena such as [[thrombosis]], [[hemorrhage]], or [[Fragmentation (reproduction)|fragmentation]] may influence [[Tumor cell|tumor]] growth, detachment, and consequently [[embolism]]. [[Complication (medicine)|Complications]] that can develop as a result of myxoma are: [[arrhythmias]], [[pulmonary edema]], [[peripheral emboli]], [[metastasis]], [[blockage of the mitral heart valve]]. The [[survival rate]]s after 5-years are 83% for benign heart tumors. | |||
==Natural History== | ==Natural History== | ||
If left untreated, cardiac myxoma progression occurs slowly. The | * If left untreated, cardiac myxoma progression occurs slowly. The overlap of various phenomena such as [[thrombosis]], [[hemorrhage]], or [[Fragmentation (reproduction)|fragmentation]] may influence [[Tumor cell|tumor]] growth, detachment, and consequently [[embolism]]..<ref name="pmid24717305">{{cite journal |vauthors=Hoffmeier A, Sindermann JR, Scheld HH, Martens S |title=Cardiac tumors--diagnosis and surgical treatment |journal=Dtsch Arztebl Int |volume=111 |issue=12 |pages=205–11 |year=2014 |pmid=24717305 |pmc=3983698 |doi=10.3238/arztebl.2014.0205 |url=}}</ref><ref name="pmid3547010">{{cite journal |vauthors=Markel ML, Waller BF, Armstrong WF |title=Cardiac myxoma. A review |journal=Medicine (Baltimore) |volume=66 |issue=2 |pages=114–25 |year=1987 |pmid=3547010 |doi= |url=}}</ref> | ||
* Constitutional [[Symptom|symptoms]], such as: [[weight loss]], [[fatigue]], and [[weakness]] are often the initial clinical presentation of cardiac myxoma [[patients]], and may resemble those from [[endocarditis]].<ref name="pmid24447924">{{cite journal |vauthors=Singhal P, Luk A, Rao V, Butany J |title=Molecular basis of cardiac myxomas |journal=Int J Mol Sci |volume=15 |issue=1 |pages=1315–37 |date=January 2014 |pmid=24447924 |pmc=3907871 |doi=10.3390/ijms15011315 |url=}}</ref> | |||
Since the majority of the cardiac myxomas are left sided, it may progress to develop mitral valve obstruction or systemic embolic events, such as | * [[Metastases]] are very uncommon in cardiac myxoma.<ref name="WanDu2019">{{cite journal|last1=Wan|first1=Yan|last2=Du|first2=Hai|last3=Zhang|first3=Lei|last4=Guo|first4=Shuang|last5=Xu|first5=Li|last6=Li|first6=Yuanyuan|last7=He|first7=Hui|last8=Zhou|first8=Lian|last9=Chen|first9=Yunping|last10=Mao|first10=Ling|last11=Jin|first11=Huijuan|last12=Hu|first12=Bo|title=Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report|journal=BMC Neurology|volume=19|issue=1|year=2019|issn=1471-2377|doi=10.1186/s12883-019-1474-4}}</ref> | ||
*Overall, [[clinical]] features of cardiac myxoma are associated with the [[Tumor cell|tumor]] size, location, and [[mobility]].<ref>Burke A, Virmani R. Tumors of the Heart and Great Vessels. Amer Registry of Pathology; 1996.</ref> | |||
*Approximately 20% of [[patients]] with cardiac myxoma are [[asymptomatic]].<ref name="ThyagarajanKumar2017">{{cite journal|last1=Thyagarajan|first1=Braghadheeswar|last2=Kumar|first2=Monisha Priyadarshini|last3=Patel|first3=Shil|last4=Agrawal|first4=Abhinav|title=Extracardiac manifestations of atrial myxomas|journal=Journal of the Saudi Heart Association|volume=29|issue=1|year=2017|pages=37–43|issn=10167315|doi=10.1016/j.jsha.2016.07.003}}</ref> | |||
*Since the majority of the cardiac myxomas are left sided, it may progress to develop [[mitral valve]] obstruction or [[systemic]] [[Embolism|embolic]] events, such as [[stroke]].<ref name="LyakerTulman2013">{{cite journal|last1=Lyaker|first1=MichaelR|last2=Tulman|first2=DavidB|last3=Dimitrova|first3=GalinaT|last4=Pin|first4=RichardH|last5=Papadimos|first5=ThomasJ|title=Arterial embolism|journal=International Journal of Critical Illness and Injury Science|volume=3|issue=1|year=2013|pages=77|issn=2229-5151|doi=10.4103/2229-5151.109429}}</ref> | |||
*Whereas, [[Right atrium|right atrial]] myxomas may obstruct the [[tricuspid valve]] and can present as [[right sided heart failure]].<ref name="ThyagarajanKumar20172">{{cite journal|last1=Thyagarajan|first1=Braghadheeswar|last2=Kumar|first2=Monisha Priyadarshini|last3=Patel|first3=Shil|last4=Agrawal|first4=Abhinav|title=Extracardiac manifestations of atrial myxomas|journal=Journal of the Saudi Heart Association|volume=29|issue=1|year=2017|pages=37–43|issn=10167315|doi=10.1016/j.jsha.2016.07.003}}</ref> | |||
==Complications== | ==Complications== | ||
Complications are common. Some of the complications that may develop as a result of myxoma are:<ref> | Complications are common. Some of the complications that may develop as a result of myxoma are:<ref name="pmid8947350">{{cite journal| author=Cina SJ, Smialek JE, Burke AP, Virmani R, Hutchins GM| title=Primary cardiac tumors causing sudden death: a review of the literature. | journal=Am J Forensic Med Pathol | year= 1996 | volume= 17 | issue= 4 | pages= 271-81 | pmid=8947350 | doi=10.1097/00000433-199612000-00001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8947350 }} </ref><ref name="pmid26832806">{{cite journal| author=Wang Z, Chen S, Zhu M, Zhang W, Zhang H, Li H et al.| title=Risk prediction for emboli and recurrence of primary cardiac myxomas after resection. | journal=J Cardiothorac Surg | year= 2016 | volume= 11 | issue= | pages= 22 | pmid=26832806 | doi=10.1186/s13019-016-0420-4 | pmc=4736655 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26832806 }} </ref><ref name="pmid31591856">{{cite journal| author=Guk HS, Lee S, Jeong HB, Ju W, Choi JS, Lee YS| title=Recurrent Embolic Stroke Associated with Long-Latency Relapsing Cardiac Myxoma. | journal=J Clin Neurol | year= 2019 | volume= 15 | issue= 4 | pages= 591-593 | pmid=31591856 | doi=10.3988/jcn.2019.15.4.591 | pmc=6785467 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31591856 }} </ref> | ||
*[[Peripheral emboli]] | *[[Peripheral emboli]] | ||
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==Prognosis== | ==Prognosis== | ||
Depending on the complications derivated from the cardiac myxoma at the time of diagnosis (embolic event or valve obstruction) the prognosis may vary. However with no complications, the prognosis is generally regarded as favorable after surgery. Recurrence rates (either locally or elsewhere in the heart) reported in 1-3% of cases. In atypical cases the rate is much higher (12-22%) | Depending on the complications derivated from the cardiac myxoma at the time of diagnosis ([[embolic]] event or [[valve]] [[obstruction]]) the prognosis may vary. However with no [[Complication (medicine)|complications]], the prognosis is generally regarded as favorable after surgery. Recurrence rates (either locally or elsewhere in the heart) reported in 1-3% of cases. In atypical cases the rate is much higher (12-22%). The [[Survival rate|survival rates]] after 5-years are 83% for [[benign]] [[heart]] [[tumors]].<ref name="pmid24717305">{{cite journal |vauthors=Hoffmeier A, Sindermann JR, Scheld HH, Martens S |title=Cardiac tumors--diagnosis and surgical treatment |journal=Dtsch Arztebl Int |volume=111 |issue=12 |pages=205–11 |year=2014 |pmid=24717305 |pmc=3983698 |doi=10.3238/arztebl.2014.0205 |url=}}</ref> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]Maria Fernanda Villarreal, M.D. [3]
Overview
If left untreated, cardiac myxoma progression occurs slowly. The overlap of various phenomena such as thrombosis, hemorrhage, or fragmentation may influence tumor growth, detachment, and consequently embolism. Complications that can develop as a result of myxoma are: arrhythmias, pulmonary edema, peripheral emboli, metastasis, blockage of the mitral heart valve. The survival rates after 5-years are 83% for benign heart tumors.
Natural History
- If left untreated, cardiac myxoma progression occurs slowly. The overlap of various phenomena such as thrombosis, hemorrhage, or fragmentation may influence tumor growth, detachment, and consequently embolism..[1][2]
- Constitutional symptoms, such as: weight loss, fatigue, and weakness are often the initial clinical presentation of cardiac myxoma patients, and may resemble those from endocarditis.[3]
- Metastases are very uncommon in cardiac myxoma.[4]
- Overall, clinical features of cardiac myxoma are associated with the tumor size, location, and mobility.[5]
- Approximately 20% of patients with cardiac myxoma are asymptomatic.[6]
- Since the majority of the cardiac myxomas are left sided, it may progress to develop mitral valve obstruction or systemic embolic events, such as stroke.[7]
- Whereas, right atrial myxomas may obstruct the tricuspid valve and can present as right sided heart failure.[8]
Complications
Complications are common. Some of the complications that may develop as a result of myxoma are:[9][10][11]
- Peripheral emboli
- Blockage of the mitral heart valve
- Syncope
- Arrhythmias
- Pulmonary edema
- Metastasis
- Sudden death
- Fusiform cerebral aneurysms
Prognosis
Depending on the complications derivated from the cardiac myxoma at the time of diagnosis (embolic event or valve obstruction) the prognosis may vary. However with no complications, the prognosis is generally regarded as favorable after surgery. Recurrence rates (either locally or elsewhere in the heart) reported in 1-3% of cases. In atypical cases the rate is much higher (12-22%). The survival rates after 5-years are 83% for benign heart tumors.[1]
References
- ↑ 1.0 1.1 Hoffmeier A, Sindermann JR, Scheld HH, Martens S (2014). "Cardiac tumors--diagnosis and surgical treatment". Dtsch Arztebl Int. 111 (12): 205–11. doi:10.3238/arztebl.2014.0205. PMC 3983698. PMID 24717305.
- ↑ Markel ML, Waller BF, Armstrong WF (1987). "Cardiac myxoma. A review". Medicine (Baltimore). 66 (2): 114–25. PMID 3547010.
- ↑ Singhal P, Luk A, Rao V, Butany J (January 2014). "Molecular basis of cardiac myxomas". Int J Mol Sci. 15 (1): 1315–37. doi:10.3390/ijms15011315. PMC 3907871. PMID 24447924.
- ↑ Wan, Yan; Du, Hai; Zhang, Lei; Guo, Shuang; Xu, Li; Li, Yuanyuan; He, Hui; Zhou, Lian; Chen, Yunping; Mao, Ling; Jin, Huijuan; Hu, Bo (2019). "Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report". BMC Neurology. 19 (1). doi:10.1186/s12883-019-1474-4. ISSN 1471-2377.
- ↑ Burke A, Virmani R. Tumors of the Heart and Great Vessels. Amer Registry of Pathology; 1996.
- ↑ Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Patel, Shil; Agrawal, Abhinav (2017). "Extracardiac manifestations of atrial myxomas". Journal of the Saudi Heart Association. 29 (1): 37–43. doi:10.1016/j.jsha.2016.07.003. ISSN 1016-7315.
- ↑ Lyaker, MichaelR; Tulman, DavidB; Dimitrova, GalinaT; Pin, RichardH; Papadimos, ThomasJ (2013). "Arterial embolism". International Journal of Critical Illness and Injury Science. 3 (1): 77. doi:10.4103/2229-5151.109429. ISSN 2229-5151.
- ↑ Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Patel, Shil; Agrawal, Abhinav (2017). "Extracardiac manifestations of atrial myxomas". Journal of the Saudi Heart Association. 29 (1): 37–43. doi:10.1016/j.jsha.2016.07.003. ISSN 1016-7315.
- ↑ Cina SJ, Smialek JE, Burke AP, Virmani R, Hutchins GM (1996). "Primary cardiac tumors causing sudden death: a review of the literature". Am J Forensic Med Pathol. 17 (4): 271–81. doi:10.1097/00000433-199612000-00001. PMID 8947350.
- ↑ Wang Z, Chen S, Zhu M, Zhang W, Zhang H, Li H; et al. (2016). "Risk prediction for emboli and recurrence of primary cardiac myxomas after resection". J Cardiothorac Surg. 11: 22. doi:10.1186/s13019-016-0420-4. PMC 4736655. PMID 26832806.
- ↑ Guk HS, Lee S, Jeong HB, Ju W, Choi JS, Lee YS (2019). "Recurrent Embolic Stroke Associated with Long-Latency Relapsing Cardiac Myxoma". J Clin Neurol. 15 (4): 591–593. doi:10.3988/jcn.2019.15.4.591. PMC 6785467 Check
|pmc=value (help). PMID 31591856.