When do you do surgery for cardiac myxoma after a stroke ?

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When do you do surgery for cardiac myxoma after a stroke ?

July 16, 2011 by dr s venkatesan

Cardiac myxoma is an infrequent cause of stroke in young . LA myxoma is the commonest tumor that can partially dislodge to cause a stroke.

It is not necessarily a tumor emboli that causes the stroke , super added thrombus is common in cerebral artery histological studies. ( In fact , some have advocated successful thrombolysis for myxoma and stroke !)

When do intervene in stroke due to myxoma ?

Image courtesy: http://www.medicalscale1.com

As soon as cardiac myxoma is diagnosed by echocardiography it is customary to call the cardiac surgeons for their opinion and feasibility of removing the tumor at the earliest.

Myxomas need not be removed in an emergency surgery even if it has caused a stroke!

What is the optimal timing of cardiac surgery in patients with a cardiac cause of stroke ?

Stroke is a major vascular event .Immediate cardiac surgery is another major vascular insult .
Extra corporeal circulation is known to affect cerebral perfusion even in normal persons. In patients with acute stroke this can have vital impact.
Anticoagulants used peri -operatively increase the risk of converting a simple stroke into hemorrhagic one.

Hence , it is advisable to wait for 4 weeks after a stroke before removing the myxoma . One can not expect a controlled studyon this issue . It is to be based on collective experience of many.

Who should decide ?

A cardiologist, a cardiac surgeon and neurologist should collectively decide along with patient’s input ( or his proxy)

When there is a dispute in timing of surgery Neurologists opinion shall prevail over others as the immediate concern is brain function.

Is there any indication at all for doing early surgery ?

High risk mobile tumors demand early removal as further strokes can be avoided. Individual discretion and institutional preferences apply.

Reference :

1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627525/pdf/TOCMJ-2-115.pdf