Cardiac myxoma

Myxoma is the most common primary benign cardiac tumor, which could lead to some fatal complications because of its strategic position. Although any age can be affected, it predominates in the age group of 30-60 years of age with more than 75% of the affected being women. The occurrence of myxomas in left and right atrium are 75% and 20% respectively.The majority of myxomas present with systemic emboli, fever and/or weight loss, or intracardiac obstruction to blood flow.1 A ‘tumor plop’ is a sound that typically occurs during early diastole and is believed to be caused by motion of the tumor striking the wall of the endocardium. The treatment is surgical excision and key aims of anesthesia care include constant monitoring of systemic blood pressure, adequate IV fluids, and judicious use of vasoactive medications to prevent a fall in systemic vascular resistance.3

Preop

  • A-line/CVP
  • Assess patient symptomatology: SOB, chest pain, changes in pulse pressure/CVP with positioning, heart sounds
  • Adequate PIV access
  • Vasopressors to help with SVR and heart rate control – mass can act as stenotic valve

Intraop

  • Induction: maintain SVR and consider slowing heart rate if mass blocking valves

Postop

2D TEE: X-plane
2D TEE: color flow through mitral valve
2D TEE: LA myxoma
2D TEE: LA myxoma w color
3D TEE: LA myxoma
From OpenAnaesthesia
2D TEE: measurement of stalk
Resected myxoma

References:

Surgical approach

Cardiac myxomas: 24 years of experience in 49 patients. European Journal of Cardio-thoracic Surgery 22 (2002) 971–977.

Anesthesia management

Hemodynamic management of a patient with a huge right atrium myxoma during thoracic vertebral surgery: A case report. Medicine (Baltimore). 2018 Sep; 97(39): e12543.

Anesthetic Management of a Patient With a Giant Right Atrial Myxoma. Semin Cardiothorac Vasc Anesth. 2016 Mar;20(1):104-9.

Anesthetic management of a patient with asymptomatic atrial myxoma for hernia repair. Anaesth Pain & Intensive Care 2016;20(2):246-248

Giant Left Atrial Myxoma Obstructing Mitral Valve Bloodflow. Anesthesiology 7 2019, Vol.131, 151-152.

Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation. Case Reports in Anesthesiology, Volume 2019, Article ID 4181502, 6 pages.

Large myxoma causing cardiac arrest during surgery. A Clinical Reports volume 1, Article number: 24 (2015).

Atrial myxomas causing severe left and right ventricular dysfunction. Annals of Cardiac Anaesthesia. Case Report: Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 450-452.

Intraoperative Diagnosis of Left Atrial Myxoma. Anesthesia & Analgesia: January 1995 – Volume 80 – Issue 1 – p 183-184

Anesthetic experiences of myxoma removal surgery in two patients with Carney complex -A report of two cases-. Korean J Anesthesiol. 2011 Dec; 61(6): 528–532.

Echocardiography

Virtual TEE: Cardiac Myxoma

Intraoperative transesophageal echocardiography assessment of right atrial myxoma resulting in a change of the surgical plan. Ann Card Anaesth 2014;17:306-8.

Mitral Valve analysis

Review article: TEE of Mitral Valve. International Journal of Perioperative Ultrasound and Applied Technologies, September-December 2013;2(3):122-130.

New Concepts for Mitral Valve Imaging.  . 2013 Nov; 2(6): 787–795.

A Quantification Approach to Echocardiography of Mitral Valve for Repair. Anesthesia & Analgesia 12(1):34-58 · July 2015

4D-transesophageal echocardiography and emerging imaging modalities for guiding mitral valve repair.  Ann Cardiothorac Surg 2015;4(5):461-462.

Method—Comparison of Transthoracic and Transesophageal Echocardiography. Clin. Cardiol. 25, 517–524 (2002)

Virtual TEE: spectral Mitral valve

Echocardiographic atlas of the mitral regurgitation. J Saudi Heart Assoc. 2011 Jul; 23(3): 163–170.

Intraoperative transesophageal echocardiographic assessment of the mitral valve repair. Ann Card Anaesth 2010;13:79-85.

 
 
 

Computer-based comparison of different methods for selecting mitral annuloplasty ring size. Journal of Cardiothoracic Surgeryvolume 12, Article number: 8 (2017)

Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography. . 2011 Jun; 12(6): 445–453.

 
 

The choice of mitral annuloplastic ring—beyond “surgeon’s preference”.  Ann Cardiothorac Surg 2015;4(3):261-265

Gold Standard to Measure MR – PPT 2016 U of Wash.

Transcatheter Mitral Valve Replacement

Our hospital will be partaking in the Medtronic APOLLO study.

The data so far from other hospitals in an easy to read format.

f14-large

PPT from Duke 2017

Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovasc Diagn Ther. 2016 Apr; 6(2): 144–159.

Role of echocardiography for catheter-based management of valvular heart disease. Journal of Cardiology 69 (2017) 66–73.

EAE/ASE Recommendations for the Use of Echocardiography in New Transcatheter Interventions for Valvular Heart Disease.  J ASE Sept 2011.

Multimodality Imaging in the Context of Transcatheter Mitral Valve Replacement. JACC: CARDIOVASCULAR IMAGING, VOL. 8, NO. 10, 2015.

Echo in mitral valve intervention. ESC 2012.

Mitral Valve Morphology Assessment: Three-Dimensional Transesophageal Echocardiography Versus Computed Tomography. Ann Thorac Surg 2010;90:1922–9.

Transcatheter Mitral Valve Replacement for Patients With Symptomatic Mitral Regurgitation. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY VOL. 69, NO. 4, 2017. 

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Transcatheter Mitral Valve Intervention, An Issue of Interventional Cardiology Clinics, E-Book.

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography.  Can Measurement Lead to Better Management? Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp. 2014.

Transcatheter valve replacement and valve repair: Review of procedures and intraprocedural echocardiographic imaging. Circ Res. 2016;119:341-356.

Philips: TMVR

Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013;26:921-64.

Transcatheter Mitral Valve Repair. Summer 2014Volume 19, Issue 2, Pages 219–237.

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Mitraclip and TEE for MR

 

Transthoracic Echocardiography (TTE)

Transthoracic echo: a beginner’s guide #tte #cardiac #echo #meded

Knowing how to do a quick focused echo exam can be instrumental in diagnosis as well as treatment.  This has helped me determine how severe cardiac tamponade has been in an emergent case prior to induction when there was no prior echo.  There are so many more useful answers that a bedside echo can provide.  Time to get acquainted.

Helpful links:

acoustic_windows
From Visible Heart Lab

Helpful articles:

b9780323089296000081_f008-001ad-9780323089296
From ClinicalGate.com