What kind of tumor is this and where does it grow?
Myxoma consists of loose gelatinous tissue and is usually attached by a stalk to the interatrial septum. In approximately three out of four cases it is located in the left atrium, less often in the right, and very rarely in the ventricles. The size varies from a few millimeters to several centimeters. When the heart contracts, a movable tumor moves to the atrioventricular orifice and temporarily disrupts blood flow. The tumor is benign: it does not invade neighboring organs and does not metastasize, but it can recur after incomplete removal.
- Most often - the left atrium
- Attached with a leg to the interatrial septum
- Movable, changes position during contractions
- The surface is loose, prone to tearing off fragments
- Does not metastasize
- Possible recurrence if removal is incomplete
Causes and risk factors
In most cases, myxoma occurs without an obvious cause, sporadically, most often in women aged thirty to sixty years. In approximately every tenth patient, the tumor is associated with a hereditary condition - Carney complex, in which myxomas are multiple, appear at a young age, are combined with pigment spots on the skin and endocrine disorders, and are more likely to recur. In such families, all close relatives are examined.
- Sporadic occurrence without obvious cause
- Female gender
- Age 30–60 years
- Carney complex - hereditary form
- Multiple myxomas and young age as a sign of a hereditary form
Symptoms
Manifestations are divided into three groups. Mechanical ones are associated with blocking the blood flow: shortness of breath, attacks of suffocation, dizziness and fainting, which are characterized by their intensification or appearance in a certain position of the body. Embolic ones occur when tumor particles tear off and are manifested by stroke, loss of vision, and acute ischemia of the limb. General symptoms resemble an inflammatory disease: prolonged low temperature, weakness, weight loss, joint pain, changes in blood tests. It is because of the latter that the diagnosis is often made late.
- Shortness of breath and asthma attacks
- Dizziness and fainting depending on posture
- Heart palpitations and interruptions
- Stroke or blockage of a blood vessel in a limb
- Prolonged low-grade fever
- Weight loss, weakness, joint pain
- Increased ESR and anemia in tests
Diagnostics
The key method is echocardiography, which shows a mobile formation in the cavity of the heart, its size, location of attachment and effect on blood flow. Transesophageal examination provides a more accurate picture of the pedicle and small details, which is important for surgical planning. Cardiac MRI and CT help distinguish myxoma from thrombus and from other tumors. Blood tests often show increased ESR, anemia, and increased inflammatory proteins. The final diagnosis is confirmed by histological examination of the removed tumor.
- Transthoracic echocardiography
- Transesophageal echocardiography
- MRI or CT scan of the heart
- Complete blood count, ESR, C-reactive protein
- ECG
- Histological examination after removal
Treatment and observation
The only treatment is open heart surgery with artificial circulation. The tumor is removed along with the area of the septum to which it is attached to reduce the risk of regrowth, and the resulting defect is closed with a patch. The intervention is not delayed: while the tumor is in place, the risk of embolism and sudden blockage of blood flow remains. The results of the operation are usually good, and the symptoms go away. After discharge, follow-up echocardiography is required - first after a few months, then annually for several years.
- Planned surgery as soon as possible after diagnosis
- Removal of the tumor along with the base
- Repair of septal defect
- Histological confirmation of diagnosis
- Control echocardiography after surgery and annually thereafter
- Examination of relatives if a hereditary form is suspected
