The long term results of treatment of heart myxomas with special attention to very rare myxoma of the right ventricle.

Fifteen patients with cardiac myxomas, 13 in the left atrium, one in the right atrium and one in the right ventricle were treated surgically during a 15 years period with no hospital and no late deaths. Left atrial myxomas revealed symptoms of obstruction to blood flow in 100%, symptoms of constitutional effects in 55% and thromboembolic events in 23%. Diagnosis of left atrial myxomas was made before operation in eleven patients by echocardiography or angiography or by both methods. In two patients diagnosis of left atrial myxoma was made incidentally during cardiac surgery for mitral stenosis. 8 left atrial myxomas originated from septum and 5 from the wall. Removal of the myxoma with the portion of the septum or the wall was performed in 11 patients and direct suture was satisfactory in 9 cases. In 2 patients septum was repaired by pericardial patch. Septum was left intact in 2 patients. Follow-up period varied from 1/2 to 15 years, mean-above 8 years. Estimation of late results was achieved by 2-D echocardiography in every patients. Results remain very good, patients are in the NYHA class 1, examinations revealed no recurrences. Special attention was paid to very rare case of huge right ventricular myxoma demonstrating wide infiltration of the endocardium and involvement of the tricuspid valve, which was completely destroyed. The technique of endocardial decortication was used for removal of the myxoma and tricuspid valve had to be replaced. Three months after operation extreme obstruction of the artificial valve was recognized. During second operation valve was cleaned from the thrombus but also fragments of the myxoma probably left during first operation were removed by wider technique of endocardial decortication. Results after 15 years remains very good. Right ventricular myxoma being on the border of operability needs more aggressive technique than simple removing.