Complications
The complications related to surgery are as encountered in other surgical procedures (e.g., pneumonia and deep vein thrombosis).
Specific complications related to myxoma surgery include: arrhythmias (most commonly atrial arrhythmias); heart block; constrictive pericarditis; post-pericardiotomy syndrome; and complications related to other associated procedures done with myxoma surgery, such as valve replacement and coronary artert bypass graft.[4][8][20][21]
Arrhythmia occurs in 16% of patients,[8] arrhythmia or atrial ventricular disorder in 26%,[4] atrial arrhythmia in 35%, pneumonia in 4.3%, cardiac tamponade in 4.3%, ventricular tachycardia in 2.2%, and brain infarction in 2.2%.[20]
In another study postoperative cerebral complications were noted in 10% of the patients, cardiac arrhythmias in 22.5%, and pericardial effusion in 4%.[22]
No guidelines or recommendations exist regarding treatment of embolic phenomena in cases of myxoma. The definitive treatment is surgical removal of the cardiac tumour.
Rarely, myxoma can embolise and this tissue can grow at a distant site. This is possibly a myxoid variant of cardiac sarcoma as the classic myxoma is not a malignant tumour that metastasises.
The treatment of embolic phenomena depends on the vascular territory involved. In cases where large vessels are involved, anticoagulation is started based on an initial diagnosis of vascular occlusion, but the definitive treatment is surgical removal of myxomatous tissue.[12]
The occlusive mass, unlike acute coronary thrombosis, is not composed mainly of platelet-rich thrombus. Hence, both intracoronary thrombolysis and mechanical revascularisation may be unsuccessful in patients presenting with myocardial infarction due to cardiac myxoma.[13][14]
Emboli may trigger small vessel inflammation and mimic a small-vessel vasculitis. Full dermatological recovery has been reported with removal of the myxoma.[19]
Anticoagulation, with or without antiplatelet therapy, is usually prescribed in the setting of an embolic phenomenon. Long term therapy of such agents after surgery is individualised.
If there is any evidence of residual heart failure, then appropriate long-term therapies (e.g., beta-blockers, ACE inhibitors, and furosemide) may be needed in individual cases.
If there is any associated condition (e.g., arrhythmias), then long-term medications may be needed for control. The incidence of arrhythmias increases in the post-operative period.
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