We reported 3 years ago the use of cryoablation in the treatment of a right atrium myxoma arising from the Koch’s triangle. The atrioventricular conduction was successfully preserved. Today, after 3 years follow-up, the patient remains with a conducted sinus rhythm and is free of recurrence. Even if extensive resection of the stack of the myxoma remains the first choice attitude, cryoablation could be considered as a serious second choice alternative.
Keywords
MyxomaCardiac tumorsKoch’s triangleCryoablation
Dear editor
We reported 3 years ago the treatment of a right atrial myxoma arising from the Koch’s triangle [1]. To preserve the atrioventricular conduction, we limited the excision of the myxoma without extensive stalk resection and we additionally applied cryoablation to reduce the risk of secondary recurrence. Despite immediate success on atrioventricular conduction, questions remains on long term evolution of the conduction and potential recurrence of the tumor. Three years after surgical resection of the tumor, based on an ultimate echocardiography (Fig. 1) and electrocardiogram at the beginning of 2016, we can state that the patient remains with preserved atrioventricular conduction and is free of tumor recurrence.
Fig. 1
Transthoracic echocardiography demonstrating the absence of recurrence in the right atrium close to the Koch’s triangle
In the literature, only one case of cryoablation in complement to surgical resection is reported [2]. This case involved a left ventricular myxoma recurrence 2 years after initial surgical resection and the use of cryoablation in complement to surgical resection. Unfortunately, the follow-up of this patient is limited to 1 year. Wang et al. [3] reported recently in an important series an overall rate of recurrence of 5%. Recurrences of cardiac myxomas after resection have been for a long time mainly attributed to incomplete resection of the myxoma’s pedicle [4, 5]. Nowadays, even if this consideration remains relevant, multicentric myxomas growth is considered as the principal risk factor for recurrence [3]. Shinfeld et al. analyzed the reported cases of recurrent myxomas and observed that up to 57% of them were diagnosed within the first 3 years following initial treatment [6]. Finally, Gerbode et al. reported that myxomas recurrence occurs preferably in men than in women [7]. After all these considerations, we can reasonably state that this 81 years old women will not likely present a local recurrence of the initial myxoma. Though we conclude that even if extensive stack resection remains the golden standard attitude, cryoablation may be considered as a valuable secondary alternative to extensive myxomas stalk resection when this excision is hazardous.
Declarations
Acknowledgements
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Funding
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Availability of data and supporting materials
The data of this article are available by request to the authors.
Authors’ contribution
SM and DM have collected the follow-up data of this manuscript. The corresponding author PW has been involved in drafting the manuscript. PW, SM and DM have been involved in revising critically the paper. All the authors have read and approved this final manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Written information consent was obtained from the patient for the publication of the initial case report and secondary evolution data. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Ethics approval and consent to participate
This study was approved by the “Comité d'éthique hospitalier du Centre Hospitalier Universitaire Brugmann (OM 026)” with the reference number CE 2016/130.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Authors’ Affiliations
(1)
Department of Cardiac Surgery, CHU Brugmann, Université Libre de Bruxelles
(2)
Department of Cardiology, Iris Sud Hospitals
(3)
Department of Cardiac Surgery, Hospital Civil Marie Curie
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