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(Chest. 2003;124:2408.)
© 2003 American College of Chest Physicians

Symptoms in Cardiac Myxoma

Nandita Scott, MD; John P. Veinot, MD and Kwan-Leung Chan, MD

University of Ottawa Heart Institute Ottawa, ON, Canada

Correspondence to: Kwan-Leung Chan, MD, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada; e-mail: kchan{at}ottawaheart.ca

To the Editor:

We read with interest the recent article by Acebo et al (May 2003).1 Myxoma is the most common primary cardiac tumor, and it is intriguing that in many patients myxomas do not cause symptoms but are detected as an incidental finding during an echocardiographic examination. It is useful to identify features of the tumor that are predictors of symptoms, in order to develop a better understanding of the mechanisms leading to the development of symptoms. We have performed an analysis of the clinical, pathologic, and echocardiographic features of cardiac myxomas that were surgically removed between 1976 and 1999 at the University of Ottawa Heart Institute. There were 34 patients (mean age, 53 ± 15 years) [± SD]. Of these, 25 patients had symptoms, and the common symptoms were dyspnea in 13 patients and embolism in 9 patients. Nine patients were asymptomatic. Two pathologic findings were more common in asymptomatic patients, namely the presence of calcification including bone, and the presence of glandular elements (p = 0.01 and p = 0.03, respectively). Regarding embolism, the pathologic predictors were absence of calcium (p = 0.004), absence of thrombus (p = 0.04), and polypoid shape (p = 0.04), whereas the only echo predictor was polypoid shape (p = 0.05). These observations were consistent with the findings of Acebo et al.1

We agree with Acebo et al1 that echocardiography is a reliable method in the diagnosis of cardiac myxoma. It also provides additional insight regarding the potential of embolism. In symptomatic patients, urgent surgical intervention is indicated. We believe that prompt surgical intervention is also justified in asymptomatic patients with polypoid myxomas so as to prevent embolism.

References

  1. Acebo, E, Val-Bernal, F, Gomez-Roman, J, et al (2003) Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience. Chest 123,1379-1385[Abstract/Free Full Text]




This Article
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