Myxoma of the heart is a primary neoplasm with intracardiac or intraventricular growth. Cardiac benign heart tumors in adult myxomas are found in 50% of cases, in children – in 15% of cases. In 75% of cases, myxoma is localized in the left atrium, in 20% – in the right; in a small proportion of patients, the tumor affects the ventricles of the heart or valvular apparatus. The predominant age of patients is from 40 to 60 years; statistically more often the tumor is detected in women.
Myxoma is a connective tissue tumor containing a large amount of mucus. In addition to the heart, myxomas can be detected in the intramuscular tissue, on the limbs, in the area of aponeurosis and fascia; less likely to affect the bladder and nerve trunks.
Tumors of the heart – a heterogeneous group of neoplasms that grows from the tissues and membranes of the heart. Tumors can develop from any tissue of the heart and occur at any age. Neoplasms can sprout the heart muscle, pericardium, affect the valves and septa of the heart. In the fetus, they can be detected using fetal echocardiography, starting from 16-20 weeks.
intrauterine development. Primary heart tumors are found in cardiology with a frequency of 0,001-0,2%; secondary (metastatic) – 25-30 times more often. All heart tumors carry the potential risk of fatal complications – heart failure, arrhythmias, pericarditis, cardiac tamponade, systemic embolism.
- Causes of
- Classification of heart tumors
- Mixa Features
- Primary benign heart tumors
- Papillary fibroelastomas
- Other benign heart tumors
- Left atrium
- Right atrium
- Ventricular myxoma
- Malignant heart tumors
- Symptoms of myxoma of the heart
- Methods of diagnosis
- Heart Tumor Treatment
- How is the removal operation performed?
- Prognosis of heart tumors
As mentioned above, the causes of myxoma of the heart are not known for certain. Some researchers adhere to the hypothesis that it develops from a parietal thrombus, which subsequently develops into a tumor. Others consider the myxoma to be a tumor itself: the detached particles of this formation are carried through the blood vessels, leading to the development of daughter neoplasms.
Benign heart tumor – myxoma
There are two varieties of cardiac mixes:
- the first is a semitransparent formation tightly adjacent to the wall with a wide base and soft consistency;
- the second is a denser tumor resembling a polyp.
The sizes detected by the mix vary and can reach several centimeters. It would seem, what danger is such a small tumor? Myxoma of small size is practically not dangerous, but the trouble is that over time, the tumor grows.
Unlike recent formations that are discovered in patients by chance during the examination, it is undoubtedly easier to identify “old” tumors, since they have larger sizes and characteristic clinical signs, as a result of which serious complications can occur.
Currently, medicine is only exploring what causes are associated with the formation of myxoma.
According to statistics, the majority of patients (85%) are over 30 years old and only 15% of patients are younger.
In rare cases, tumors are congenital. Their frequency is 1 case per 10 newborns.
Possible causes of this disease:
- Hereditary predisposition. If one or more relatives of the patient suffered this disease, then the risk of developing myxoma increases. Sometimes a tendency to this pathology can be inherited, along with Carney’s syndrome (the occurrence of several benign tumors on the skin, testicles, adrenal glands and heart).
- Injury or unsuccessful surgery. If injured or after unsuccessful surgery on the heart muscle, the risk of a tumor increases.
- The presence of tumors of other organs. With the development of benign tumors on other organs, the occurrence of myxoma becomes more likely. This process has not been scientifically recognized, but statistics confirm this statement.
- Gender It is not known why this happens, but women suffer from this ailment 4 times more often than men.
- Age factor. The risks of myxoma increase with age and increase greatly after 30 years.
The exact causes of the mix of the heart have not yet been clarified, but there is a generally accepted list of factors affecting their development. You can familiarize yourself with it below:
- hereditary predisposition to cancer;
- neoplasm development in other places;
- genetic abnormalities;
- transeptal puncture;
- transferred injuries of the heart muscle;
- balloon valvuloplasty of the mitral valve.
Sometimes the development of myxomas is affected by the pathological processes of the chronic course. Because of them, the work of the heart is disrupted, which is a trigger (trigger) for the appearance of a neoplasm.
The causes and conditions of myxoma are not fully established.
In approximately 10% of cases, tumors are familial in nature, with an autosomal dominant type of inheritance. Most often, with a hereditary disease, myxoma is part of Carney’s syndrome – a disease that is also characterized by diffuse pigmented skin changes (freckles, nevuses), adrenal cortical hyperplasia, subcutaneous neurofibromas, hemangiomas, pituitary tumors with gigantism or acromegaly, myxoid fibroma .
Most mix are sporadic (single, random) in nature and are not inherited. They develop, presumably, from mucoid embryonic tissue. The predominant localization zone is the area of the interatrial septum, which is explained by its tendency to tissue proliferation, which persists after birth. After removal, such tumors almost never recur.
Cardiology does not exclude the likelihood of developing myxoma due to various heart injuries, percutaneous balloon dilatation of the mitral valve, plastic surgery of septal defects, transeptal puncture, etc.
The question of etiology is not completely clear. In approximately 7-10% of cases, they are familial in nature with an autosomal dominant type of inheritance. In this case, most often myxoma is part of the hereditary Carney syndrome, which is also characterized by diffuse pigmented skin changes (multiple nevi, freckles, hyperpigmentation of the lips), hemangiomas, subcutaneous neurofibromas, adrenal cortical hyperplasia, myxoid fibroadenoma of the mammary gland, or gygromyophysis tumors tumors of the testicle.
Sporadic myxomas are usually solitary; after removal, they almost never recur; hereditary forms – multilocular, often occur again after surgical excision. Myxoma is thought to develop from mucoid embryonic tissue. The predominant localization of myxoma in the area of the interatrial septum is explained by the tendency of this zone to tissue proliferation, which persists after birth.
In cardiology, the likelihood of myxoma due to heart injuries, previous plasty of septal defects, percutaneous balloon dilatation of the mitral valve, transeptal puncture, etc.
Macroscopically, myxoma has the appearance of a polypoid tumor on the leg with a loose jelly-like consistency, papillary or cluster-like structure. Myxomas can reach sizes from 1 to 15 cm in diameter and a mass of 250 g. Histologically, the myxoma is represented by a matrix consisting of mucopolysaccharides, in which polygonal tumor cells are scattered. Myxoma contains many capillaries and larger vessels, there are foci of necrosis, hemorrhage, calcification.
It has not yet been possible to determine in detail the causes of the formation of myxoma of the heart, however, there are generally accepted factors that can provoke the appearance of a tumor in the heart:
- genetic predisposition to cancer;
- puncture through the septum;
- carney syndrome;
- organ damage suffered;
- valvotomy of aortic balloon.
Chronic organ diseases that interfere with its normal functioning can also contribute to the occurrence of atrial myxoma or heart. The risk group includes people who already have a cancerous tumor in another area of the body. There is also a hereditary factor. The development of the disease due to hereditary causes is observed more often than due to other factors.
Classification of heart tumors
Tumors of the heart, representing independent diseases, are primary; tumors that metastasize through the blood and lymph vessels or sprouting from neighboring organs – secondary. The causes of the development of primary heart tumors are unknown. Secondary heart tumors are more often represented by metastases of breast, stomach, lung, and less commonly thyroid and kidney cancer.
According to the morphological principle, heart tumors are divided into benign (75%) and malignant (25%). By origin, malignant neoplasms can be both primary and metastatic, secondary. Among benign tumors, there are myxomas of the heart (50-80%), teratomas, rhabdomyomas, fibromas, hemangiomas, lipomas, papillary fibroelastomas, pericardial cysts, paragangliomas, etc. Malignant neoplasms include sarcomas, pericardial mesotheliomas and lymphomas.
Pseudotumors include foreign bodies of the heart, organized blood clots, inflammatory formations (abscesses, gums, granulomas), echinococcal and other parasitic cysts, calcification conglomerates. A separate group consists of extracardial tumors of the mediastinum and pericardium, compressing the heart.
Myxoma of the heart muscle is a benign formation of the primary type, germinating in the atria and ventricles. The ICD-10 code for her review is D15.1. This abbreviation stands for international classification of diseases. It is used as a regulatory document, which collects methods of examination and treatment. The ICD also contains macro-preparations, that is, special images and statistical data that facilitate the diagnosis.
According to international classification information, the origin of myxoma may be different. Some experts insist that the neoplasm is formed from a parietal thrombus. Other scientists regard the myxoma as a true tumor, arguing their point of view with its structure.
In appearance, the neoplasm is divided into 2 types:
- Broad-base, colorless tumor. She holds onto the wall tightly and, in its consistency, resembles jelly.
- A polyp-like neoplasm that is attached on a leg to the wall of the heart muscle. It is much denser than the first variety.
The surface of the tumor is smooth. Its contents resemble jelly in appearance and consistency. Over the years, myxomas calcify and “stiffen”. They get nutrition thanks to capillaries and arterioles. Due to the fragile structure, myxoma particles come off easily and can clog vessels.
The size of the neoplasm varies from 1 to 2-3 cm. Initially, it does not manifest itself in any way. The danger threatens a person with time, when the tumor begins to grow. The process is accompanied by a vivid clinical picture. If you do not remove the formation in a timely manner, then the likelihood of developing complications, often leading to death, is increased.
Myxomatosis or myxoma? Many people do not know what mitral valve myxomatosis is, therefore they confuse it with myxoma of the heart. In the first case, the essence of the problem lies in the defect in the structure of the valve apparatus. In the second embodiment, we are talking about neoplasms of the primary species. Associated mitral valve myxomatosis and myxoma can only be similar symptoms caused by a malfunction of the heart muscle.
What is myxoma is not known to everyone, but this neoplasm is common enough, especially in people from thirty-five to sixty-five years old. In some cases, myxoma can be diagnosed in childhood, but these are exceptional cases. Myxoma, which forms in the heart muscle, is a benign tumor formation that is located in the atria and ventricles.
Outwardly, the myxoma has a smooth surface and has fastening to the wall of the heart muscle with a wide base, or, like a polyp, with a foot. The content of the neoplasm in consistency resembles jelly. Inside the myxoma is also filled with capillaries and large vessels. The size of the heart in the presence of education does not change, but sometimes there is an isolated increase in the affected area.
In some cases, myxoma can be confused with mitral valve myxomatosis. It is initially a separate neoplasm, and myxomatosis is a heart disease, which is a defect in the construction of the valvular apparatus of the heart. Both pathologies have similar symptoms, which is due to impaired functionality of the heart muscle.
The stenosing effect of the neoplasm depends on its size and location. So, atrial myxoma:
- Right: obstructs (blocks) the right atrioventricular opening, which violates the venous outflow of blood and, thereby, leads to the development of the superior vena cava syndrome. Symptoms of atrial myxoma appear when the tumor reaches about 10-12 cm;
- Left: becomes the cause of obstruction of the left atrioventricular orifice, which makes it difficult to drain blood from the pulmonary veins. Symptoms of the pathology are manifested when a neoplasm is reached 7 cm in diameter. This atrial myxoma is the most common.
- Right: stenoses the mouth of the pulmonary trunk;
- Left: narrows the outflow tract of the left ventricle.
Symptoms of atrial myxoma are similar to the clinic of tricuspid or mitral stenosis. Ventricular tumors mimic the clinical course of pulmonary stenosis or subvalvular aortic stenosis.
Primary benign heart tumors
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Half of the cases among all primary heart tumors occur in the myxoma. Sporadic myxomas of the heart are 2-4 times more often found in women. There is a Karni hereditary complex with an autosomal dominant type of inheritance, characterized by multicentric tumors of various localization – heart myxomas, pigmented skin tumors, mammary fibroadenomas, ovarian cysts, adrenal nodular dysplasia, myxoid tumors of the testicles, pituitary adenomas, and pituitary adenomas.
The predominant localization of the mix is the left atrium (about 75%). Myxomas with a pedicle prolapse through the mitral valve, making it difficult to empty the left atrium and fill the ventricle during diastole. Macroscopically, myxomas can have a mucous, solid, lobed, or loose structure. Unformed loose myxomas pose the greatest danger in terms of the development of systemic embolism.
Among primary heart tumors, the second most frequent are benign papillary fibroelastomas, mainly affecting the aortic and mitral valves. Morphologically, they represent avascular papillomas with branches resembling anemones, extending from the central nucleus. Most often they have a leg, however, unlike a mix, they do not cause valve dysfunction, but increase the likelihood of an embolism.
Among all benign heart tumors, rhabdomyomas account for 20% and are the most common neoplasm in children. Usually rhabdomyomas are multiple, have intramural localization in the septum or wall of the left ventricle, affect the conduction system of the heart. The course of rhabdomyoma can be accompanied by tachycardia, arrhythmias, heart failure. These heart tumors are often associated with tuberous sclerosis, sebaceous adenomas, benign neoplasms of the kidneys.
Connective tissue heart tumors are also mainly found in children. They can affect the valves and the conduction system of the heart, cause mechanical obstruction, simulating valve stenosis, the clinical picture of heart failure, hypertrophic cardiomyopathy, constrictive pericarditis. Heart fibromas can be part of the basal cell nevus syndrome (Gorlin syndrome).
Other benign heart tumors
Hemangiomas occur in 5-10% of all primary heart tumors. More often they do not cause clinical symptoms and are detected during a routine examination. Less commonly, intramyocardial hemangiomas are accompanied by disturbances in atrioventricular conduction, and with the germination of the atrioventricular node can lead to sudden death.
Heart lipomas can develop at any age. Typically, these are tumors on a broad base, localized in the epicardium or endocardium. The course of lipomas is often asymptomatic; upon reaching large sizes, they can cause arrhythmias, conduction disturbances, a change in the shape of the heart, detected radiologically.
Pheochromocytomas can have intrapericardial or myocardial localization, accompanied by secretion of catecholamines. Pericardial cysts on chest radiographs often mimic heart tumors or pericardial effusion. More often they are asymptomatic, sometimes they can cause chest compression symptoms.
More often, a pathological tumor forms in the region of the left atrium, however, it can also occur in the right part of the organ, or in its ventricles. Sometimes there are cases when doctors reveal multiple formations that simultaneously affect different chambers of the heart.
Myxoma of the left atrium is diagnosed in seventy-five percent of cases. The danger of this arrangement is the deterioration of the venous outflow, as well as a decrease in the size of the mitral orifice. In addition, patients can greatly increase blood pressure and develop heart failure.
Myxoma of the right atrium occurs in only twenty of one hundred patients. Such localization becomes a cause of violations of the outflow of venous blood, which is due to obstruction of the right atrioventricular valve. This condition causes increased pressure.
It is rare to encounter a myxoma, which affects the ventricles of the heart, since a similar location of the tumor is found only in 5% of cases of pathology diagnosis. A manifestation of this localization is signs of obstructive cardiomyopathy.
Many people are diagnosed with a mix of the left atrium. On the right side, it is less common and is hardly detected in the ventricles. Sometimes doctors find multiple tumors in several departments at the same time.
Depending on its localization, myxoma causes various symptoms and complications. See the location options below:
- In the left atrium, a tumor is detected in 75% of cases. Due to its location, it causes malfunctions in the venous outflow and reduces the mitral orifice, increasing blood pressure and contributing to the development of heart failure.
- In the right atrium, a neoplasm is found only in every fifth patient. The venous outflow is disturbed due to the narrowing of the right atrioventricular opening, which is manifested by an increase in pressure.
- Myxoma occurs in the left or right ventricle in only 5% of cases. It manifests itself with signs of obstructive cardiomyopathy.
Often they find a myxoma near the oval fossa or on the wall (back, front) of the left atrium. Sometimes, due to its size and degree of mobility, it sinks into the ventricle, disrupting hemodynamics and clogging the valve opening. In this situation, the tumor is detected between the valves.
The method of diagnosis and treatment depends on the location of this benign tumor. Myxoma is constantly increasing in size and if untreated leads to death.
The following places of its localization are distinguished:
- Damage to the cavity of the left atrium – leads to venous congestion in the lungs, impaired loading of the left ventricle, hypoxia of the body, increased blood pressure and the progressive development of disorders in the blood supply system of the lungs.
- The defeat of the right atrium also disrupts the outflow of blood and increases pressure, as a result of which venous blood cannot circulate correctly. In this case, typically the right atrium is affected 3 times less often than the left.
- The occurrence of myxoma in the region of the right or left ventricles is extremely rare, there is severe shortness of breath, frequent fainting and the presence of pain.
- The tumor can also come from the walls of the interventricular septum, supraventricular ridge, tricuspid (tricuspid) valve, mitral, aortic valve and chordal filaments.
Determining the exact location of the tumor is the key to a correct diagnosis.
At the first stages of the disease, external manifestations are not observed and this complicates the diagnostic process. When the tumor reaches a large size, the first manifestations begin, which are difficult to ignore.
Malignant heart tumors
Sarcomas are the most common primary malignant heart tumors. They are found mainly at a young age (average age 40 years). Heart sarcomas can be represented by angiosarcomas (40%), undifferentiated sarcomas (25%), malignant fibrous histiocytomas (11-24%), leiomyosarcomas (8-9%), rhabdomyosarcomas, fibrosarcomas, liposarcomas, osteosarcomas. Malignant heart tumors more often occur in the left atrium, leading to mitral obstruction, cardiac tamponade, heart failure, and lung metastasis.
Pericardial mesotheliomas are relatively rare and are found mainly in men. They usually metastasize to the pleura, spine, brain, surrounding soft tissues.
Primary lymphomas more often affect people with immunodeficiency (including HIV infection). These heart tumors are prone to extremely rapid growth and are accompanied by heart failure, arrhythmias, tamponade and superior vena cava syndrome.
Metastatic heart tumors most commonly affect the pericardium, less commonly the heart muscle, endocardium, and heart valves. Like primary heart tumors, they can cause shortness of breath, acute pericarditis, cardiac tamponade, rhythm disturbances, atrioventricular block, congestive heart failure. Lung, breast, renal cancer, soft tissue sarcoma, leukemia, melanoma, lymphoma, Kaposi’s sarcoma can metastasize in the heart.
Symptoms of myxoma of the heart
It is possible to detect the presence of a tumor in any zone of the heart due to specific manifestations of a clinical nature that develop during the growth of the neoplasm.
In patients with myxoma, the following symptoms may occur:
- thromboembolism syndrome – myxoma, located in the right heart chambers, causes pulmonary embolism;
- cardiac blood flow obstruction syndrome – usually manifested by shortness of breath, hypertension (increased blood pressure) and tachycardia (increased heartbeat);
- heart failure – usually occurs suddenly, while it cannot be stopped with any medications;
- fainting and shortness of breath – frequent dizziness and sudden cases of loss of consciousness are possible with circulatory failure, if the localization of the myxoma is very close to the valve opening;
- decrease in platelet level – during diagnostic tests, an indicator of platelet level of about 155 thousand/μl and below is determined;
- the presence of heart murmurs that were not previously detected during preventive medical examinations.
In addition to these signs, with the appearance of myxoma in patients, a syndrome of systemic or constitutional manifestations can also develop. Such signs include anemia, increased weakness, high fever.
In the clinical picture of the formation and increase in the size of myxomas, 3 different syndromes are distinguished:
- Systemic manifestations;
- Intracardiac obstruction.
1. The common symptoms of myxoma include: fever, general weakness, weight loss. Blood tests can detect anemia, accelerated ESR, thrombocytopenia, dysproteinemia, increased levels of immunoglobulins, elevated levels of CRP (C-reactive protein). Against the background of the tumor, Raynaud’s syndrome, polyarthralgia, reticular livida often develop.
2. Thromboembolic syndrome is observed in patients in approximately 40-50% of all cases. It is caused by blockage of the vascular bed by thrombotic masses or tumor fragments.
A neoplasm developing in the left parts of the heart becomes a cause of damage to the arteries of the large circle of blood circulation: most often these are coronary (myocardial infarction) and cerebral (ischemic stroke) arteries. Retinal artery embolism provokes persistent or transient loss of vision.
Myxoma of the right heart causes thromboembolism of the pulmonary artery and leads to the formation of chronic pulmonary hypertension. Thromboembolic syndrome with myxoma of the heart can cause sudden death.
3. Intracardiac obstruction syndrome is accompanied by shortness of breath, orthopnea (shortness of breath in a prone position, forcing to assume a sitting position), dizziness, short-term episodes of loss of consciousness, tachycardia, hemoptysis, arterial or pulmonary venous hypertension, peripheral edema. The appearance of certain signs and their severity can change both when changing the position of the body, or when moving the tumor.
Manifestations of heart tumors are caused by the type of neoplasm, its localization, size, and ability to decay. Extracardiac tumors are manifested by fever, chills, weight loss, arthralgia, skin rashes. When the tumor compresses the chambers of the heart or coronary arteries, shortness of breath and chest pain occur. Tumor growth or bleeding can lead to the development of cardiac tamponade.
Tumors of the heart with intramyocardial growth (rhabdomyomas, fibromas), compressing or introducing into the conducting system, are accompanied by atrioventricular or intraventricular blockade, paroxysmal tachycardia (supraventricular or ventricular).
Intracavitary heart tumors mainly disrupt valve function and inhibit blood flow from the heart chambers. They can cause the phenomena of mitral and tricuspid stenosis or insufficiency, heart failure. Symptoms of intracavitary heart tumors usually occur when the body position changes due to a change in hemodynamics and physical forces acting on the tumor.
Often, the first manifestations of heart tumors are thromboembolism in the vessels of the systemic or pulmonary circulation. Tumors from the right heart can cause pulmonary embolism, pulmonary hypertension, and pulmonary heart; tumors of the left heart — transient cerebral ischemia and stroke, myocardial infarction, limb ischemia, etc. The occurrence of heart attacks in young people in the absence of congenital and acquired heart defects, atrial fibrillation, and infective endocarditis makes one think of the presence of a heart tumor.
Three main syndromes prevail in the clinical picture of myxomas: systemic manifestations syndrome, thromboembolic syndrome, intracardiac obstruction syndrome. General symptoms develop in more than 90% of patients with myxoma of the heart and are characterized by fever, general weakness, weight loss. Anemia, accelerated ESR, thrombocytopenia, increased levels of immunoglobulins, dysproteinemia, and elevated levels of CRP are detected in the blood. Against the background of myxoma, polyarthralgia, reticular Livedo, Raynaud’s syndrome can develop.
Thromboembolic syndrome, caused by blockage of the vascular bed by tumor fragments or thrombotic masses, occurs in 40-50% of cases with heart myxoma. With a myxoma of the left heart, arteries of a large circle of blood circulation are affected, most often cerebral (ischemic stroke) and coronary (myocardial infarction). With thromboembolism of the retinal arteries, transient or permanent loss of vision occurs. Embolism of the mesenteric vessels leads to occlusion of the mesenteric vessels. Myxoma coming from the right heart serves as a source of pulmonary embolism and the formation of chronic pulmonary hypertension. Thromboembolism with myxoma of the heart can lead to sudden death.
Intracardiac obstruction syndrome is accompanied by pulmonary venous or arterial hypertension, dyspnea, hemoptysis, orthopnea, tachycardia, dizziness, short-term episodes of loss of consciousness, and the development of peripheral edema. With a myxoma of the heart, the onset and severity of these symptoms can change with a change in body position and tumor movement.
Symptoms of myxoma of the heart are as follows:
- The development of heart failure, not amenable to therapeutic methods of treatment;
- Peripheral embolism, especially in young people;
- The rapid progression of the disease, in contrast to cardiac rheumatism;
- Shortness of breath for no apparent reason or even fainting;
- Thrombocytopenia (decreased platelet count in the blood);
- Angiotrophoneurosis (Raynaud’s syndrome);
- The appearance in the heart of noise;
- Tachycardia (increased heart rate);
- High blood pressure (arterial hypertension);
- In some cases – anemia, or anemia, increased erythrocyte sedimentation rate, general weakness, increased low-grade fever (about 37º).
Since the above symptoms are also manifested in various other diseases, it is very difficult to diagnose myxoma.
Methods of diagnosis
Due to the variability of the clinical picture and the multiplicity of morphological forms of heart tumors, their diagnosis is not an easy task.
ECG data for heart tumors are polymorphic and not very specific: they can reflect signs of cardiac chamber hypertrophy, conduction and rhythm disturbances, myocardial ischemia, etc. Chest x-ray often reveals an increase in heart size and signs of pulmonary hypertension. An ultrasound scan of the heart is a more sensitive method for diagnosing tumors: with the help of transesophageal echocardiography, atrial tumors are better visualized, with transthoracic echocardiography – ventricular tumors.
In case of doubtful diagnostic results, MRI and MSCT of the heart, radioisotope scanning, sounding of the heart cavities and ventriculography are performed. To verify the histological structure of a heart tumor, a biopsy is performed during catheterization or diagnostic thoracotomy. With exudative pericarditis, valuable diagnostic information can be obtained from a cytological examination of the fluid obtained by pericardial puncture. Differential diagnosis of heart tumors is performed with CHD, myocarditis, cardiomyopathy, pericarditis, cardiac amyloidosis.
More often, patients seek the help of medical staff already in the late stages of the development of pathology, which in most cases explains the late appearance of symptoms of the disease. Sometimes a delayed visit to the hospital is often caused by a fear of hospitals or simply a negligent attitude to one’s own health.
First, the doctor interviews the patient and collects an anamnesis, then prescribes the necessary diagnostic tests.
Diagnosis in cardiology involves:
- ECG cardiogram;
- x-ray of the heart;
- CT scan;
- magnetic resonance imaging.
During the diagnosis of the disease, the differentiation of the tumor from other pathologies and neoplasms of the heart is of particular difficulty. The results of the studies allow us to accurately establish the type and nature of the neoplasm, and also to evaluate the size and location of the tumor in the organ.
Modern medicine can offer many diagnostic methods for almost any neoplasm, but individually they do not always allow you to establish the correct diagnosis. Therefore, the diagnosis of myxoma of the heart is a comprehensive examination of the patient.
One of the first cardiological examination procedures is electrocardiography. With the help of an ECG of the heart, pathological changes in the size of the atria can be detected: their hypertrophy is often accompanied by myxoma.
In parallel with the ECG for the study and diagnosis of disorders, cardiac phonocardiography (FCG) is used. In the presence of a tumor on the phonocardiogram, I splitting can be detected. If the myxoma on the heart is located in the left atrium, then there is no tone for the opening of the mitral valve, and diastolic murmur is also recorded.
Radiography of the heart allows you to get an image of an organ for further analysis by a specialist. X-ray examination serves as a tool for identifying external pathological changes. In particular, one of the signs of myxoma of the left atrium may be a change in the width of its cavity, as well as calcification clearly visible on x-rays.
Vascular angiography – as one of the radiological methods of research, involves the introduction of a special contrast agent in the veins or cavities of the heart
Ultrasound examination does not allow for an absolutely reliable determination of the type of formation: the rounded formation found in the left atrium may indicate a myxoma, or it may turn out to be an intracavitary thrombus.
However, the most accurate diagnosis can be made on the basis of magnetic resonance therapy (MRI), which today is one of the most informative methods for diagnosing heart tumors. A histological examination of the emboli obtained by surgical intervention is also performed.
The auscultatory picture and phonocardiography data for myxoma can be variable, however, heart murmurs usually change with a change in body position and tumor displacement relative to the valve. ECG changes are nonspecific and make it possible to judge only the functional state of the heart. An X-ray of the chest often reveals the mitral form of the heart, signs of venous congestion in the lungs, sometimes foci of myxoma calcification.
Crucial is given to transthoracic or transesophageal echocardiography. With the help of ultrasound of the heart, a volumetric formation is detected, its localization and size, the place of attachment of the leg and mobility are determined. The data obtained are refined by conducting atriography, ventriculography, CT and MRI of the heart. Coronary angiography is performed for all applicants for surgical treatment over the age of 40 years.
Differential diagnosis is carried out with combined mitral and tricuspid heart defects, infectious endocarditis, Ebstein’s anomaly, constrictive pericarditis, collagenoses, heart malignancies and other localizations. If histological verification of myxoma is necessary at the preoperative stage, cardiac catheterization and endomyocardial biopsy are performed.
Most patients come to the clinic already with “outdated” mixes of rather large sizes. Procrastination is associated with a lack of symptoms in the early stages of tumor development. Initially, the doctor will interview the patient to determine the symptoms that concern him and their frequency of occurrence. Next, the specialist will conduct an examination and appoint a series of examinations to determine the size, type and location of the neoplasm. Their list is as follows:
- Electrocardiography (ECG) is the main method for diagnosing heart disease. With its help, you can detect certain violations of the rhythm of contractions and impulse conduction that arose due to the growth of myxoma. The severity of changes directly depends on the degree of narrowing of the holes between the departments.
- Phonocardiography can detect splitting of the first tone. A similar deviation is characteristic of neoplasms in the heart muscle. If the myxoma is in the left atrium, the device will detect diastolic murmur and detect the loss of tone that occurs when the mitral valve opens.
- Echocardiography allows you to get the most accurate information about the size and location of the tumor, so it is often performed before surgery. Thanks to its smooth surface, a distinct echo can be detected during heart contraction. In cases with other pathological processes, the data obtained are more blurry.
- Radiography is an additional method of examination. It is prescribed to detect structural changes in the heart muscle (width of the atria, swelling of the ear). Sometimes its departments are equally enlarged. The calcification process characteristic of the “old” mixes is clearly visible on the x-ray.
- Angiocardiography is an effective method for examining the heart by injecting a contrast medium. During the procedure, the doctor may detect a defect in the filling of blood vessels caused by tumor growth. The disadvantage of this type of diagnosis is the inability to recognize the type of neoplasm.
- Magnetic resonance imaging or computed tomography is prescribed before the operation to determine the size of the myxoma, its location and penetration depth.
The complexity of the diagnosis lies in the similarity of the clinical picture of myxoma with other diseases (myocarditis, collagenosis) and neoplasms (lipomas, teratomas). For accurate differentiation, a series of examinations will be required and similar pathologies should be excluded. Based on the diagnostic results, it will be possible to determine the type of tumor, its nature, size and localization.
Crucial in the diagnosis of this pathology is given to such an ultrasound diagnostic study of the heart as transthoracic echocardiography. If it was not possible to establish a diagnosis with it, transesophageal echocardiography is prescribed.
Ultrasound of the heart allows you to detect a volumetric formation in the heart, to determine its size and localization, the place of attachment and leg mobility.
To refine the data, CT and MTR of the heart are sometimes performed, arteriography, ventriculography, coronarography.
Confirmation of the diagnosis of “myxoma of the heart” requires its differentiation from combined mitral and tricuspid heart defects, Ebstein’s anomaly, infectious endocarditis, collagenosis, constrictive pericarditis, and malignant tumors.
Heart Tumor Treatment
Radical treatment of myxoma involves the surgical removal of an intracavitary heart tumor. Due to the high risk of thromboembolic complications and sudden death, immediate surgery is indicated immediately after diagnosis.
Myxoma is removed from the median longitudinal sternotomy approach under moderate hypothermia and IR. During the operation, not only the tumor itself, but also the place of its attachment is excised, and therefore, plastic surgery of the atrial septal defect with a pericardial patch is often required. During the operation, it is extremely important to prevent intraoperative embolism with tumor fragments. For this purpose, the digital revision of the cavities of the heart is excluded; removal of the tumor is carried out in a single block with a constricted aorta and cardioplegia; thorough washing of the heart cavity after removal of the myxoma is performed.
If the myxoma is damaged by the mitral or tricuspid valves, their plastic or prosthetics are performed.
Tumors of the heart are treated surgically. Surgery for heart tumors may include removal of an intracavitary tumor, removal of a myocardial or pericardial tumor, pericardectomy, removal of a pericardial cyst. During a radical operation, a heart tumor with adjacent surrounding tissues is excised, suturing or plastic defect. Benign heart tumors in most cases can be removed radically. In some cases, patients may need plastic or valve prosthetics.
Removal of primary malignant heart tumors is ineffective. In this case, they most often resort to partial (palliative) removal of the tumor, followed by radiation or chemotherapy. In secondary heart tumors, treatment is also palliative.
Treatment of myxoma, like all benign tumors, involves the surgical removal of the tumor. Moreover, the operation is indicated immediately – immediately after the establishment of an accurate diagnosis, which is explained by the high risk of developing thromboembolic complications and sudden death.
During the operation, the tumor itself is excised, the place of its attachment and the area of the heart surrounding the leg. Quite often, patients subsequently require atrial septal defect plastic.
Radiation treatment of myxoma is not effective.
The surest method of treatment for patients is surgery to remove myxoma. Of course, this is a radical way, but it minimizes the risk of complications and allows you to save the life of the patient. There are still medical and folk methods of treating myxoma of the heart, but they can only make a person feel better, but they will not save him from the tumor.
Removal of a myxomatous tumor is carried out in this way:
- A chest opening is performed to gain direct access to the heart.
- The patient is connected to a heart-lung machine.
- An incision is made in the heart, where the myxoma is localized.
- The neoplasm leg intersects.
- Correction of other identified defects (correction of the septum, valve replacement) is performed, which allows you to quickly recover after the operation.
- Disconnection of the operated from the cardiopulmonary bypass.
Prices for conducting such an operation in different clinics can vary significantly, which can be explained by various factors. But, to prevent complications during the operation, it is better to go to a clinic with a good reputation. Surgical intervention is complex and requires a high level of professionalism of the surgeon.
Despite the fact that myxoma is a benign tumor, its growth can lead to mitral stenosis (narrowing of the left atrioventricular opening), which with a 30% probability can lead to sudden death of the patient.
The cause of death can also be a tumor embolism, which is dangerous because groups of cancer cells, penetrating the bloodstream, can clog vessels and lead to ischemic stroke. Therefore, it is important to diagnose the pathology in a timely manner and proceed to its treatment, without leading to embolic complications.
Many people are afraid of operations. Not all tumors require surgical intervention – therapy also copes. Unfortunately, myxoma is not treated with therapeutic methods: medications can relieve some symptoms and improve the patient’s condition, but they can’t cure the myxoma.
An enlarged tumor poses a threat to human life and leads to various complications. Therefore, it is in no case recommended to delay the treatment: the statistics show that after the onset of signs of the disease, people die on average in two years.
An operation to remove myxoma of the heart performed by qualified surgeons is safe. During the operation, a thoracotomy is performed, the patient is connected to the AIK (heart-lung machine). The corresponding chamber of the heart is opened and the tumor is removed, then the atrial septal defects are sutured.
How is the removal operation performed?
Therapeutic methods of treatment are not able to rid the patient of myxoma. This disease is treated with surgery.
Therapy can somewhat alleviate the symptoms of the disease, but only removal will help restore the patient to his former life.
The operation is frightening for many patients, but procrastination can be fatal.
In the overwhelming majority of cases, heart surgery to eliminate myxoma takes place without any complications, but the risk of their occurrence cannot be ruled out anyway.
Complications during surgical procedures may arise due to such factors:
- poor preparation for the operation;
- sudden attack of anemia;
- inaccessible location of myxoma;
- infection of the heart cavities during surgical procedures.
After surgery, the patient needs about two days in the intensive care unit under the constant supervision of doctors.
After removal of myxoma of the heart, some complications may also occur:
Prognosis of heart tumors
After removal, patients usually forever forget about myxoma, although in rare cases, especially in people with hereditary tumors, the disease can recur. Relapses also occur in those cases when when removing multiple mixes, their attachment points are not completely excised.
In general, the prognosis after surgery for myxoma of the heart is favorable. The vast majority of patients who have undergone this operation, finally recover.
Timely diagnosis is the key to successful treatment of myxoma of the heart.
The first alarming “bells” for the patient should be the following signs of a tumor on the heart:
- cases of sudden loss of consciousness;
- frequent dizziness;
- inability to sleep in a horizontal position;
- shortness of breath and respiratory failure;
- the appearance of pulmonary wheezing;
- the appearance of edema on the legs;
- speech impairment.
The presence of any of the above symptoms is the basis for seeking medical attention. Timely surgery significantly increases the patient’s chances of recovery.
In the absence of treatment and ignoring the symptoms of the disease, a sudden death can overtake the patient. The clinical course of the tumor can have a malignant and even fatal course, which is associated with frequent complications. The main cause of death is thromboembolism – a process in which a blood clot breaks off and enters the circulating blood.
In this case, clogging of small branches of arteries occurs. The cessation of blood supply to the “zone of responsibility” of the small artery leads to tissue necrosis (heart attack). As a rule, it takes 2-3 years for the tumor to grow to life-threatening sizes.
The risk of sudden death in patients with myxoma is 30%. With the natural course of the disease, life expectancy does not exceed 2 years from the onset of symptoms. The death of patients is usually associated with tumor embolism or occlusion of the valve openings of the heart.
After surgery, most patients experience a complete recovery or improvement. Postoperative tumor relapses occur in 1-2% of cases with isolated heart myxoma and in 12-22% with hereditary syndromes. With solitary myxomas, the re-emergence of tumors is usually associated with incomplete excision of the site of their attachment.
Forecasts for patients are mostly favorable, provided timely and adequate treatment. The probability of a sudden fatal outcome in patients with diagnosed myxoma in the region of the heart is no more than 30%.
If the tumor is not treated, the life expectancy does not exceed three years from the onset of the first symptoms. After heart surgery, a complete recovery of the patients is usually observed, but sometimes a worsening of the condition due to the development of complications is also possible. The possibility of relapse is observed only in 1-2% of cases.
There is no specific prevention of this pathology. However, people who fall into the high risk group for morbidity to reduce the risk of heart tumors are advised to carefully monitor their health and lead a healthy lifestyle. You also need to regularly undergo a full medical examination, as this allows you to detect pathology earlier and conduct appropriate therapy.
Removal of single benign heart tumors is usually accompanied by good separated results – 3-year survival is 95%. In the future, patients are shown observation by a cardiologist and cardiac surgeon with annual echocardiography for the timely detection of recurrence of a heart tumor.
Since the onset of the first symptoms of myxoma, a person’s life expectancy does not exceed two years (with the natural course of the disease). The risk of sudden death is approximately 30%, with mortality associated mainly with occlusion of the valve openings of the heart or thromboembolism.
In almost all patients, after treatment of myxoma, complete recovery occurs. Relapses occur: with an isolated tumor – in 2% of cases, with hereditary syndromes – in 12-22%.
In the case of solitary mixes, relapses are usually the result of incomplete excision of the tumor or its attachment site.