Cardiac myxoma is one of the most common primary cardiac tumors, with about 75% of the tumors being benign . Cardiac myxoma is more common in women, with a 2:1 female preponderance. Most commonly affected age-group is 30–60 years [5, 6]. These are rarely seen in children, and account for only 9–15% of all cardiac tumors from birth to adolescence . Left atrium is the most common site of myxoma, although these may occur in the left or right ventricle.
Most myxomas have a stalk, are gelatinous, and have a broad base. The surface may be friable or villous. On histological examination, myxoid stroma can be seen stained blue in the mucus tumor cells because of the abundant mucopolysaccharide acid content. Primary cardiac tumors are classified as mucinous and non-mucinous tumors according to the histological type. Most primary cardiac tumors are mucinous tumors, while less than 5% are non-mucinous tumors.
The mucinous body tends to grow into the cardiac chamber and is connected with the wall by means of a stalk attached to the atrial septum . The shape of the mucinous body can be globular, lobulated or papillary, and has a jelly-like macroscopic appearance. Most mucinous bodies feature a hemorrhagic spot and necrosis, which facilitates embolization.
Patients will often have constitutional symptoms such as anemia, fever, and weight loss. These patients may present with systemic embolization (cerebral or peripheral) or with symptoms due to intracardiac obstruction . In current practice, myxomas are often discovered in asymptomatic patients, which can be easily missed and lead to delayed diagnosis. Such patients also may have a cardiac rumble, caused by obstruction of intracardiac blood flow by the tumor. Transthoracic echocardiography should be performed in all patients with suspected cardiac myxoma. In this case, the patient underwent echocardiogram, CT and PET/CT; however, the results from transthoracic echocardiography provided detailed anatomical correlates and was found to particularly valuable in preoperative risk assessment and preparation of a surgical plan.
Owing to its peculiar location, enmasse removal of the myxoma in the right ventricles is inadvisable because of the contiguity of the tumor with the cardiac muscles at the apex of the heart. Any damage to cardiac muscle, chordae tendineae, muscuil papillares, valves or conductive bundle is liable to impair cardiac function directly and may even prolong the postoperative recovery. Due diligence is required during surgery to remove multiple myxomas.
The mortality is significant between the time of diagnosis and the operative intervention because of massive embolization or total obstruction to intracardiac blood flow. Approximately, 8% of patients with myxoma die during the waiting period for surgery. The operative mortality is reported at 2–5% . Therefore, after the diagnosis has been established, surgery should be performed promptly due to the possibility of embolic complications or sudden death. Because of the impaired heart function and poor general condition, the patient was treated for about 2 weeks prior to the operation. Surgical outcome is generally good; 20-year survival rate is 85% . The recurrence rate after resection is approximately 5%.
The girl in the current report had multiple myxomas in the left and right ventricles, which makes it a very rare clinical case. The patient was referred for open-heart surgery and the multiple myxomas were completely removed. She recovered well after surgery; postoperative recovery and follow-up period has been uneventful till date.