Myxomas are the most common form of tumour found within the heart and are benign. The peak incidence is between the 3rd and 6th decades of life and they are more common in women than men. Approximately 75% are found in the left atrium (LA). They can cause problems by one of three mechanisms:
- Obstruction of the normal pattern of blood flow within the heart – this can lead to symptoms of shortness of breath and collapse (syncope) which can sometimes be exacerbated by a change in body position.
- Embolization – this means that part of the tumour or clot attached to it breaks off and travels to a different part of the body. It occurs in 30-40% of patients and if the embolic event is to the brain, this is manifested as a stroke.
- Constitutional symptoms – these include weight loss, fever and lethargy.
These must be excised to prevent embolization or obstruction. The standard surgical approach has been the median sternotomy and for many of these tumours this is still the best approach.
However, for those with a relatively narrow stalk, what we call pedunculated, a minimally invasive approach through a 5cm incision on the right side of the chest can be performed, much in the same way that we perform keyhole mitral valve surgery. The advantage of this approach over a sternotomy is less discomfort and speedier recovery.
Have a read of Amy’s story who actually discovered her own tumour 2 weeks before she was due to get married and had this procedure performed – she did not have a single visible scar on the big day and apparently danced all night (click here).