Surgical management of atrial myxoma and study of its inflammatory status: A single center study

Ahmed  Farouk; Nashwa  Abd elhafez; Gamal  Ahmed Yassein Nassar; Ahmed  Mohamed Mandour; Mohamed  Osman; Amr AA Othman; Shimaa H Shaban; Alia S Ali; Eman Radwan; Mohamed  Farouk Abd elhafez

Ahmed Farouk Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
Nashwa Abd elhafez Department of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
Gamal Ahmed Yassein Nassar Metabolic and genetic disorders unit, Faculty of Medicine, Assiut University, Assiut, Egypt
Ahmed Mohamed Mandour Department of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
Mohamed Osman Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
Amr AA Othman Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
Shimaa H Shaban Department of Oncologic Pathology, South Egypt Cancer institute, Assiut University, Assiut, Egypt
Alia S Ali Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
Eman Radwan Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Biochemistry, Sphinx University, Assiut, Egypt
Mohamed Farouk Abd elhafez Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt

Keywords: Cardiac Myxoma, Echocardiography, Median sternotomy

Abstract

Background: Cardiac myxomas are rare tumors mostly located in the left atrium, less often in right atrium and occasionally in all heart chambers. The aim of the present study is to report on the early outcomes and expression of inflammatory markers associated with the surgical treatment of myxoma patients between years 2018 up to 2023.

Methods: The study included thirteen patients diagnosed with atrial myxoma. Five patients were retrospective cases under follow up and eight patients underwent prospective surgery. All patients were diagnosed by transthoracic echocardiography, then underwent median sternotomy for complete tumor resection. Left atrial myxoma was found in eleven cases while right atrial myxoma were found in two cases. Blood samples were obtained pre- and post-operatively from the eight prospective cases to determine the protein levels inflammatory markers IL-6 and TNF-α in addition to mRNA levels of IL-6.

Results: Female patients represented 69.23% of total patients. Shortness of breath was involved in 61.53%, palpitation in 15.38% and atrial fibrillation in 15.38%. of patients. Mean tumor size was 3.75±1.6 cm. No recurrence or mortality were recorded and only one case of wound infection was found (7.69%). Biochemical results revealed significant increase (p<0.05) in IL-6 levels pre-operatively (99.25 ± 8.78 pg/mL) compared to post-operatively (41.13 ± 10.40 pg/mL). Moreover, IL-6 gene expression showed down-regulation in post-operative blood samples (p<0.05). In addition, TNF-α levels were significantly increased (p<0.05) pre-operatively (97.5 ± 16.34 pg/mL) compared to post-operatively (42.38 ± 8.03 pg/mL).

Conclusion: Transthoracic echocardiography is the best diagnostic tool for myxoma diagnosis, median sternotomy with complete tumor resection decrease the rate of recurrence and mortality. Moreover, cardiac myxomas are associated with a distinct inflammatory state, evident by increased circulating inflammatory mediators as IL-6 and TNF-α which may act as markers in follow up to avoid recurrence.