Three years follow-up after cryoablation of a right atrial myxoma arising from the Koch’s triangle

Journal of Cardiothoracic Surgery, Nov 2016

We reported 3 years ago the use of cryoablation in the treatment of a right atrium myxoma arising from the Koch’s triangle. The atrioventricular conduction was successfully preserved. Today, after 3 years follow-up, the patient remains with a conducted sinus rhythm and is free of recurrence. Even if extensive resection of the stack of the myxoma remains the first choice attitude, cryoablation could be considered as a serious second choice alternative.

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Three years follow-up after cryoablation of a right atrial myxoma arising from the Koch’s triangle

Wauthy et al. Journal of Cardiothoracic Surgery Three years follow-up after cryoablation of a right atrial myxoma arising from the Koch's triangle P. Wauthy 0 3 D. Mircev 2 S. Marinakis 1 0 Department of Cardiac Surgery , CHU Brugmann , Université Libre de Bruxelles , Place Van Gehuchten 4, 1020 Brussels , Belgium 1 Department of Cardiac Surgery, Hospital Civil Marie Curie , Chaussée de Bruxelles 140, 6042 Charleroi , Belgium 2 Department of Cardiology, Iris Sud Hospitals , Rue Jean Paquot 63, 1050 Brussels , Belgium 3 Department of Cardiac Surgery , CHU Brugmann , Université Libre de Bruxelles , Place Van Gehuchten 4, 1020 Brussels , Belgium We reported 3 years ago the use of cryoablation in the treatment of a right atrium myxoma arising from the Koch's triangle. The atrioventricular conduction was successfully preserved. Today, after 3 years follow-up, the patient remains with a conducted sinus rhythm and is free of recurrence. Even if extensive resection of the stack of the myxoma remains the first choice attitude, cryoablation could be considered as a serious second choice alternative. Myxoma; Cardiac tumors; Koch's triangle; Cryoablation - limited to 1 year. Wang et al. [3] reported recently in an important series an overall rate of recurrence of 5%. Recurrences of cardiac myxomas after resection have been for a long time mainly attributed to incomplete resection of the myxoma’s pedicle [4, 5]. Nowadays, even if this consideration remains relevant, multicentric myxomas growth is considered as the principal risk factor for recurrence [3]. Shinfeld et al. analyzed the reported cases of recurrent myxomas and observed that up to 57% of them were diagnosed within the first 3 years following initial treatment [6]. Finally, Gerbode et al. reported that myxomas recurrence occurs preferably in men than in women [7]. After all these considerations, we can reasonably state that this 81 years old women will not likely present a local recurrence of the initial myxoma. Though we conclude that even if extensive stack resection remains the golden standard attitude, cryoablation may be considered as a valuable secondary alternative to extensive myxomas stalk resection when this excision is hazardous. © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Fig. 1 Transthoracic echocardiography demonstrating the absence of recurrence in the right atrium close to the Koch’s triangle Acknowledgements Not applicable. Availability of data and supporting materials The data of this article are available by request to the authors. Authors’ contribution SM and DM have collected the follow-up data of this manuscript. The corresponding author PW has been involved in drafting the manuscript. PW, SM and DM have been involved in revising critically the paper. All the authors have read and approved this final manuscript. Ethics approval and consent to participate This study was approved by the “Comité d'éthique hospitalier du Centre Hospitalier Universitaire Brugmann (OM 026)” with the reference number CE 2016/130. 1. Marinakis S , Mircev D , Wauthy P. Cryoablation for a right atrial myxoma arising from the Koch's triangle: a case report . J Cardiothorac Surg . 2013 ; 8 : 222 . Rathore KS , Hussenbocus S , Stuklis R , Edwards J. Novel Strategies for Recurrent Cardiac Myxoma . Ann Thorac Surg . 2008 ; 85 ( 6 ): 2125 - 6 . Wang Z , Chen S , Zhu M , Zhang W , Zhang H , Li H , Yuan G , Zou C. Risk prediction for emboli and recurrence of primary cardiac myxomas after resection . J Cardiothorac Surg . 2016 ; 11 ( 1 ): 22 . McCarthy PM , Schaff HV , Winkler HZ , Lieber MM , Carney JA . Deoxyribonucleic acid ploidy pattern of cardiac myxomas . Another predictor of biologically unusual myxomas . J Thorac Cardiovasc Surg . 1989 ; 98 : 1083 - 6 . J Cardiovasc Surg (Torino). 2001 ; 42 ( 3 ): 345 - 8 . Shinfeld A , Katsumata T , Westaby S. Recurrent cardiac myxoma: seeding or multifocal disease ? Ann Thorac Surg . 1998 ; 66 ( 1 ): 285 - 8 . Surgery. 1967 ; 61 ( 1 ): 94 - 101 .


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P. Wauthy, D. Mircev, S. Marinakis. Three years follow-up after cryoablation of a right atrial myxoma arising from the Koch’s triangle, Journal of Cardiothoracic Surgery, 2016, 154, DOI: 10.1186/s13019-016-0548-2