Resection of left atrial myxoma in a patient with retrosternal gastric tube: a case report

Abstract The median sternotomy remains the standard approach in cardiovascular surgery but, in some conditions, it can be considered difficult to perform, especially in patients with history of esophagectomy. This case report describes a successful resection of a left atrial myxoma through a right anterolateral thoracotomy approach in a patient with a previous retrosternal gastric tube reconstruction. The decision for the best surgical approach was made after a heart surgery team discussion. Through this surgical access, a safe and excellent exposure of the left atrium was possible, and a complete resection of the myxoma was performed without any injury to the gastric tube.

Resultados quirúrgicos y seguimiento postoperatorio de mixomas auriculares / Surgical results and monitoring of postoperative atrial myxomas

Resumen: Objetivo: Analizar la casuística del mixoma auricular izquierdo, haciendo énfasis en los resultados y seguimiento. Método: Se revisaron los expedientes clínicos de los pacientes operados de mixomas cardiacos en el Hospital Central Sur de Alta Especialidad (HCSAE) de PEMEX en los últimos 7 años, haciendo hincapié en los resultados y seguimiento. Resultados: El análisis mostró 10 pacientes, de los cuales el 60% fueron mujeres y el 40% varones; las edades fueron de los 12 a los 76 años, con una edad media de 50 años. En las características clínicas de los pacientes predominó la disnea en un 90%, seguido de la fatiga (80%) y dolor torácico (60%). La incidencia fue del 90% para la aurícula izquierda y del 10% en aurícula derecha, hubo tumores de menos de 3 cm hasta mayores de 10 cm (media de 6-7 cm). El informe de patología fue de mixoma en el 100% de los casos, La morbimortalidad temprana fue del 0%, con una estancia hospitalaria promedio de 6 días; una paciente de 12 años tuvo una recidiva y se sometió otra vez a cirugía 5 meses más tarde. La supervivencia a 5 años es del 100%. Conclusiones: Se sabe que la presentación de Mixomas es muy poco frecuente, la experiencia en este Centro de Concentración Nacional, es de un paciente por cada 350 cirugías, en promedio un caso por año con una nula mortalidad y una excelente supervivencia.

Abstract: Objective: To analyze the casuistics of left atrial myxoma with emphasis on results and follow-up. Method: We reviewed the clinical records of patients operated in the Hospital Cardiac Myxomas South Central High Specialty (HCSAE) of PEMEX in the last 7 years, with an emphasis on results and follow-up. Results: The analysis showed 10 patients, of whom 60% were female and 40% male, with ages from 12 to 76 years, with a mean age of 50 years. In the clinical characteristics of patients predominated dyspnea in 90%, followed by fatigue (80%) and chest pain (60%). The incidence was 90% for the left atrium and 10% for the right atrium, had tumors less than 3 cm to up to over 10 cm (average of 6 to 7 cm). The pathology report was myxoma in the 100% of cases, the morbidity and early mortality was 0%, with a mean hospital stay of 6 days, and a patient of 12 years of age recurred and underwent surgery five months later. The 5-year survival was 100%. Conclusions: The incidence of myxomas is well known for rare presentation, the experience in this national medical center is one patient for every 350 operations, one case per year with no mortality and excellent survival.

Mixoma do tecido mole cervical: relato de caso e revisão da literatura / Myxoma of cervical soft tissue: case report and literature review

Introdução: Mixomas são tumores mesenquimais benignos que ocorrem raramente na região da cabeça e do pescoço. A maioria das lesões é de origem odontogênica e envolvem os ossos da face. Mixomas do tecido mole são muito raros e amplamente distribuídos pelo corpo, sendo mais freqüentemente relatados na musculatura cardíaca. Objetivo: Descrever um raro caso de mixoma do tecido mole extramuscular em região submandibular esquerda. Relato do Caso: Paciente do sexo masculino portador de mixoma extramuscular em loja submandibular esquerda, inicialmente conduzido como um cisto branquial. O tratamento consistiu na excisão cirúrgica com margens adequadas e posterior confirmação histológica do mixoma. Conclusões: A ressecção com margens adequadas é o tratamento de escolha para evitarem recidivas e o seguimento ambulatorial deve rigoroso.

Introduction: Myxomas are benign mesenchymal tumors that rarely occur in the head and neck area. Most of these injuries are odontogenic and involve facial bones. Myxomas of the soft tissue are very rare and widely distributed in the body, and most frequently reported in the heart muscles. Objective: To describe a case of extramuscular soft tissue myxoma in the left submaxillary area. Case Report: A male patient was referred to our service with extramuscular soft tissue myxoma in the left submaxillary area initially behaved as a branchial cyst. The treatment consisted of surgical excision with adequate margins and subsequent histology confirmation of the myxoma. Conclusions: The adequate resection of extramuscular myxoma is the main choice to avoid local failure, and the follow-up must be rigorous.

Mixoma de átrio esquerdo associado a derrame pleural / Left atrial myxoma associated with pleural effusion

Homem de 65 anos apresentando emagrecimento, dispnÚia e derrame pleural (DP) recorrente. A avaliaçäo cardiológica evidenciou ruflar diastólico (3/6) no foco mitral e hiperfonese da 1ª bulha. O ecocardiograma e o estudo hemodinâmico mostraram uma grande massa tumoral no átrio esquerdo (AE), sugerindo mixoma e hipertensäo pulmonar. A biópsia pleural revelou pleurite crônica inespecífica. O paciente foi submetido à operaçäo com circulaçäo extracorpórea para exérese do tumor de AE e o estudo histopatológico confirmou o diagnóstico de mixoma. O DP tem sido manifestaçäo muito rara do mixoma cardíaco (MC), que às vezes apresenta somente sinais e sintomas inespecíficos de doença inflamatória crônica