Infected myxomas in combination with emboli were reported to greatly elevate the risk for systemic embolization. The decrease in inflammatory cytokine levels after tumor removal reinforces this finding.
It has been shown that inflammatory cytokine levels were increased in patients with cardiac myxomas, which may stimulate the increased production of larger platelets. Our study found that MPV level and the platelet count also play an important role in the embolism of patients with cardiac myxoma. However, their role in myxoma-related embolism is still uncertain. The high platelet count was found to be associated with an elevated risk of cancer-associated thrombosis. It was reported previously that enlarged platelets were metabolically more active and reflect higher thrombogenic potential. Mean platelet volume and platelet count are 2 important indices of hemostasis and dysfunction. Platelets play an important role in several thromboembolic events. Irregular surface contributes to tumor fragmentation and increased interactive areas, resulting in embolism. Consistent with established results reported in the literature, our study confirmed that surface of the myxoma was an important risk factor contributing to embolism (HR: 2.701 P=0.0216). Įmbolism in patients with cardiac myxomas is associated with tumor appearance, location, and mobility. Macroscopically, the surface of myxomas is classified into 2 types ( Figure 2): the irregular type has a surface with a soft consistency and multiple exquisite villous extensions on the surface, and an irregular or villous surface and the polypoid type has a compact consistency with polypoid appearance and smooth surface. Atypical myxomas arise from other sites of the left atrium or in the other cardiac chambers. Typical myxomas arise from the interatrial septum at the border of the fossa ovalis in the left atrium. Patients’ clinical profile was retrieved, including sex, age, body surface area, body mass index, history of atrial fibrillation or flutter, concomitant valvular heart disease, pulmonary artery hypertension, coronary artery disease, blood coagulation function, intravascular ultrasound, and characteristic features of the myxomas (size, appearance, location, attachment). Based on clinical presentation and cranial computed tomography, patients were classified into embolic and non-embolic groups.
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