New Trend of Cardiac Myxoma - Case Series and Systematic Review

Abstract

Although rare, cardiac myxomas are the most common primary cardiac tumor with an incidence of 0.5 per million per year. Previous case series have reported on the epidemiology, clinical characteristics, diagnostic technologies and therapeutic outcomes that were evident at the time of publication. Because of the evolution of cardiac diagnostic (particularly imaging) and therapeutic options, we theorized that cardiac myxomas would be found at an earlier stage and this would result in improved therapeutic outcomes. Accordingly, a new case series (Current Group) is being reported and compared to historical case series that were published after widespread availability of echocardiography (after 1985). The case series were further divided into those published before (group 3), after (group 1) or overlapping (group 2) the proliferation of chest and cardiac imaging technologies that occurred in the mid-1990s. All 28 patients with pathologically proven cardiac myxoma at Florida Hospital Orlando from April 2007 to August 2013 (the Current Group) were studied. For comparative review, PubMed was searched for case series of cardiac myxoma from January 1, 1985 to December 31, 2013, and studies that met inclusion criteria were divided into three groups: Group 1: cases collected exclusively after 1995 (10 articles); Group 3: cases exclusively before 1995 (31 articles); and Group 2: those not belonging to group 1 or 3 (23 articles). The gender (2:1 female predominance), age and myxoma location (85% left atrium) have not changed significantly over time. However, the tumor size has declined from 5.3 cm to 3.3 cm. Asymptomatic cases (found unexpectedly) have increased to 21% of the Current Group while fever, heart failure and embolism have declined over time. Echocardiography has become the dominant diagnostic technology, followed by CT. Catheter based diagnostic imaging has declined substantially. Surgical mortality and tumor recurrence have remained low but unchanged. In summary, cardiac myxoma has trended to smaller, more frequently asymptomatic tumors found mostly by echocardiography or CT, but this has not altered surgical mortality or recurrence.