Common Complications Of Myxoma

ObjectiveRetrospective analysis about the clinical characteristics of cardiac myxomas,especially in patients accompanied with common complications 。 By discussing the diagnosis、theatment and prognosis of those patients to promote the quality of their life,decrease hospital stays and hospital costs,provide a therapy about diagnosis and treatment for these people.MethodsTo discribe the clinical datas of 58 cardiac myxoma patients hospitalized in cardiac department of Qilu hospital subordinate to Shandong university between August 2011 and January 2015.All patients were diagnosed by ultrasonic cardiogram.Collect their clinical datas such as initial symptoms、signs at admission、 auxiliary examinations、preoperative preparations、the operation time、operation method and hospitalization time.According to complications, patients were divided into four groups:accompanied with cerebral embolism group,accompanied with valvular disfunction group,accompanied with coronary stenosis group and without serious complications group.Sum up the experience about diagnosis and treatments of these patients,explore surgical approaches and their prognosis,reserch whether the complications have influence on patients’recovery.Results1. General information:in this study, the patients’ age ranked from 23 to 78,most of them were belong to 50-70,took a proportion of 61%.The ratio of female to male was about 2:1.There were 51 case (88%) found in left atrium,7 case(12%) found in right atrium,no case found in left or right ventricle primarily.The most patients had only one myxoma in heart chamber,3 case were found 2 myxomas in left atrium.2. Clinical symptoms:41 case(69.5%) with chest congestion,asthma and anhelation primarily.13 case(22%) had symptoms that result from cerebral or other vessel embolism.6 case(10%) appeared symptoms result from blood stream blocked.6 case(10%) without obvious symptoms,they always picked during health examination.3. Signs:auscultatory findings:30(50.8%) case with diastolic or systolic murmur.12 case(20.3%) with low cardiac sound.4 case(6.7%) with arrhythmia.Purcussion findings:21 case(35.6%) with enlargement of relative cardiac dullness.5 case(8.4%) with signs resulted from embolization.9 case(15.2%) without obvious signs when admitted to hospital.4. Auxiliary examinations:After echocardiography all the patients were pointed that they have cardiac space-occupying lesions. After 17 patients taking coronary arteriongraphy,7 patients had coronary artery stenosis and needed operation,13 patients were diagnosed with myxoma and valvular dysfunction, 5 patients were checked by Brain CT or MRI and other parts CT, all of them had cerebral ischemic infarction or peripheral vascular filling defect. There were 6 patients with arhythmia checked by electrocardiogram:one was complete left bundle branch block, one was sick sinus syndrome, one was paroxysmal supraventricular tachycardia, three were atrial fibrillation.5. Complications:In this group of cases, there are 11 patients (19%) who have cerebral embolism,13 patients (22%) who have valvular dysfunction,13 patients (22%) who have coronary atherosclerosis,5 patients (9%) who have arrhythmia,19 patients (33%) who have PAH,12 patients (21%) who have hypertension,17 patients (29%) who have cardiac insufficiency,5patients (9%) who have diabetes, and 7 patients (12%) without any complications.6. Treatments:five cases of all patients didn’t have operation. The average operation time of patients who only remove of myxoma is about 204 minutes. And the average length of hospital stay is about 19 days. The average length of hospital stay after operation is about 10 days. The average coast during the period of hospitalization is about 68086 yuan. The average operation time of patients who remove of myxoma and have coronary artery bypass grafting is about 271 minutes. And the average length of hospital stay is about 21 days. The average length of hospital stay after operation is about 13 days. The average coast during the period of hospitalization is about 102510 yuan. The average operation time of patients who remove of myxoma and have cardiac valve repair or valve replacement is about 235 minutes. And the average length of hospital stay is about 22 days. The average length of hospital stay after operation is about 11 days. The average coast during the period of hospitalization is about 83700 yuan. Of all patients who remove of myxoma, only one case removed by thoracoscope, the others were by mid-sternal incision and cold-induced extracorporeal circulation. Patients who have the left atrial myxoma were operated on the interauricular septum of atrium dextrum. And those who have the right atrial myxoma were operated on the atrium dextrum by extracorporeal circulation. Conclusions1. Cardiac myxoma patients lact of specific clinical symptoms,always with symptoms resulted from embolization or blood stream blocked.Echocardiography is the first choice to diagnose myxoma, others auxiliary examination can also implied patients complicated with valvular disfunction,embolization and coronary stenosis.2. Patients with cerebral vessel embolization can get operation.3. Patients with coronary stenosis can receive CABG simultaneously.4. Valvular operation can be carried through simultaneously if patients with valvular disfunction.5. Cardiac myxoma patients can be treated through thorachoscopic surgery.6. Myxoma at specific location needn’t have rigorous excised.7. Careful inspection is necessary to avoid tumor embolization after surgery.8. Different complication has different effect on patients.To prevent and treat these complications positively can help petients with decreasing cost and shortening hospital stay.