Excision of calcified left atrial myxomas: a surgical challenge

Atrial myxomas are the most frequent primary cardiac tumors and are typically cured by surgical resection. Prognosis is excellent in most cases, but complex tumors that involve adjacent valvular or septal structures may lead to challenging repairs and adverse outcomes. We present two patients with atrial myxomas who underwent surgery with strikingly different results. The first, a 72-year-old woman, had a broad-based, calcified left atrial myxoma encroaching on the mitral annulus. Following resection, annular stability was preserved with annuloplasty and patch reinforcement, resulting in successful repair and excellent recovery. The second, a 68-year-old man, underwent excision of a calcified myxoma but developed complete heart block, anterior mitral leaflet perforation requiring repair, and an acquired Gerbode defect. Despite reoperation with pericardial patch repair and tricuspid annuloplasty, he later required redo mitral and tricuspid valve replacements with ECMO support and ultimately died of multiorgan failure. These cases illustrate contrasting outcomes after atrial myxoma surgery. While curative resection is common, complex tumors near the mitral annulus or atrioventricular septum may cause structural injury, conduction disturbances, and rare complications such as Gerbode defect. Careful preoperative imaging, meticulous intraoperative assessment, and long-term vigilance are essential to optimize outcomes.