Volume 41 - Issue 4

INTRODUCTION: Cardiac myxoma (CM) is the most common primary cardiac tumor. Multiple CMs are rare and can lead to heart failure and arterial embolism. This study aimed to explore clinical characteristics, surgical treatment experience, and follow-up strategies for multiple CMs.
METHODS: A retrospective analysis was conducted on eight patients with multiple CMs who underwent surgical treatment. Clinical characteristics were analyzed by extracting relevant clinical data, electrocardiography and echocardiography findings, surgical treatment details, and postoperative follow-up information. All patients had undergone cardiopulmonary bypass surgery. Pathological analysis was performed on all tumors, and postoperative cardiac ultrasound follow-up was also conducted.
RESULTS: Multiple CMs were uncommon, representing only 5.9% of all cases. Among 136 patients with cardiac tumors admitted during the same period, only eight had multiple CMs. All patients with multiple CMs underwent complete tumor resection. The size of the resected tumors was approximately 5 – 80 (39.3 ± 20.3) mm. The follow-up period ranged from one to nine years. The recurrence rate was 37.5% (3/8), and all recurrent cases underwent reoperation for tumor resection. There were no perioperative deaths, and overall surgical outcomes were satisfactory.
CONCLUSION: Our study reveals that surgery is the best strategy for multiple CMs. The tumor should be completely resected, and color Doppler echocardiography is recommended every six months postoperatively to detect tumor recurrence. Those cases of multiple myxomas have had high recurrence rate after resection (37.5%) but were submitted successfully to a new resection. Timely surgical resection provides favorable outcomes for patients with multiple or recurrent CMs.

INTRODUCTION: The Ozaki procedure reconstructs the aortic valve with autologous pericardium, but long-term leaflet durability remains uncertain. Coronary artery disease (CAD) may reflect a systemic atheroinflammatory milieu associated with impaired leaflet integrity.
METHODS: We retrospectively studied 733 patients undergoing Ozaki reconstruction from 2015 to 2020 and assessed the association between CAD and aortic regurgitation (AR) ≥ 2 at last echocardiographic follow-up. Baseline heterogeneity was addressed using propensity-score overlap weighting based on age, sex, body mass index, body surface area, weight, diabetes, European System for Cardiac Operative Risk Evaluation II, aortic stenosis, bicuspid valve, and peripheral artery disease. Effects were estimated as weighted risk ratios (RRs) using Poisson models with robust variance. Sensitivity analyses used stabilized inverse probability of treatment weighting (IPTW) and an extended model including prior myocardial infarction/percutaneous coronary intervention.
RESULTS: Of 733 patients, 365 (49.8%) had CAD. Unadjusted AR ≥ 2 rates were 10.1% in CAD vs. 5.7% in no-CAD patients (P = 0.037). After overlap weighting, weighted risks were 12.7% vs. 6.2%, yielding RR 2.05 (95% CI, 1.01 – 4.18; P = 0.048), with excellent covariate balance. IPTW showed consistent results: RR 2.22 (95% CI, 1.38 – 3.56; P = 0.001). Regurgitation-free survival was lower in CAD patients (log-rank P = 0.0087).
CONCLUSION: CAD was associated with an approximately two-fold higher risk of AR ≥ 2 after Ozaki reconstruction. This association likely reflects systemic atheroinflammatory processes rather than a direct mechanical effect, supporting closer postoperative surveillance in CAD patients.