Surgical Resection of

Atrial Myxomas
MARITES HILL, RN, BSN; CECILE CHERRY, RN, MSN, CNOR;
MARTIN MALONEY, RN, BSN; PAULA MIDYETTE, RN, MSN, CCRN, CCNS 3.3
www.aorn.org/CE

ABSTRACT
Myxomas are the most common form of benign cardiac tumors; these tumors occur
primarily in the atria. Most myxomas are idiopathic in origin, but in rare cases,
patients have a family history of myxomas. Although these tumors are benign,
myxomas have the potential to cause serious complications, including embolic
events and partial or complete obstruction of intracardiac blood flow. Currently,
there is no effective medical treatment, and surgical excision of the tumor is
necessary. Typically, surgical resection of an atrial myxoma is performed via a
median sternotomy with the patient on cardiopulmonary bypass. Recurrence of a
myxoma after surgical excision is extremely rare, and most patients have an excel-
lent prognosis after surgery. AORN J 92 (October 2010) 393-406. © AORN, Inc,
2010. doi: 10.1016/j.aorn.2010.06.012

Key words: cardiac surgery, cardiac tumor, myxoma, atrial myxoma, neoplasm.

M
yxomas are primary benign tumors that
occur in the chambers of the heart.
Although myxomas may develop in
any chamber of the heart, approximately 75% of
myxomas develop in the left atrium, 23% in the
right atrium, and the remaining 2% in the ventri-
cles.1 Traditionally, surgical resection of atrial
myxomas is accomplished via a sternotomy inci-
sion with the patient on cardiopulmonary bypass
(CPB). Reports in recent literature indicate that
indicates that continuing education contact
hours are available for this activity. Earn the con-
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purpose/goal and objectives, and completing the
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doi: 10.1016/j.aorn.2010.06.012
© AORN, Inc, 2010
robotic-assisted resection of atrial myxomas is
being performed, but this approach is still uncom-
mon.2 Atrial myxomas have a very low rate of
recurrence after surgical excision, and most pa-
tients will have an excellent long-term prognosis
after the surgical procedure.
CARDIAC TUMORS
Tumors affecting the heart can be primary or sec-
ondary and benign or malignant. Primary cardiac
tumors arise from the tissues of the heart, whereas
metastatic tumors spread to the heart either from
a distant tumor via the bloodstream or by local
infiltration from tissues surrounding the heart.
Approximately 75% of primary tumors are be-
nign, and the most commonly occurring classifi-
cations of primary cardiac tumors are myxomas,
fibroelastomas, hemangiomas, and fibromas.
October 2010 Vol 92 No 4 ● AORN Journal 393
October 2010 Vol 92 No 4 HILL—CHERRY—MALONEY—MIDYETTE

 originate in the intra-atrial septum, with the

body of the tumor extending into the intracar-
diac chamber;
 have an average size of 5 cm at the time of di-
agnosis, although they may vary widely in size;
 are round or oval in shape; and
 are attached to the endocardium by a pedicle
(ie, stalk) that may allow some mobility of the
tumor, depending on the length of the pedicle
(Figure 1).
Papillary tumors, a less common form of myx-
oma, have a gelatinous composition (Figure 2)
Figure 1. Atrial myxoma tumor with pedicle
and are prone to fragmentation. It is uncommon
attachment. for fragments to break off from solid myxomas.5

CLINICAL PRESENTATION OF
Approximately 25% of primary cardiac tumors ATRIAL MYXOMAS
are malignant, and almost all primary malignan- Although cardiac myxomas can occur in men or
cies that develop in the heart are sarcomas, typi- women at any age, approximately 75% of patients
cally angiosarcoma or rhabdomyosarcoma. Pri- with atrial myxomas are women, and the mean
mary malignant tumors of the heart are more age of patients with atrial myxomas is 56 years.1
likely to involve heart structures, whereas meta- Clinical manifestations of atrial myxoma fall into
static diseases are more prone to spread to the three classifications: tumor-related obstruction to
pericardium.3 Malignant diseases responsible for intracardiac blood flow, tumor-related embolic
most secondary tumors affecting the heart are events, and systemic symptoms. The most com-
lung cancer, breast cancer, and melanoma.4 Exci- mon presenting symptoms are caused by ob-
sion of cardiac tumors of all types accounts for an structed cardiac blood flow, and the severity of
estimated one in every 500 cardiac surgical proce- the symptoms is affected by the size, position,
dures performed.5 and degree of mobility of the tumor. The most
commonly obstructed area is the mitral valve; this
MYXOMAS
Myxomas are the most common type of primary
cardiac tumor, accounting for 50% of all primary
cardiac tumors.5 Myxomas very rarely affect chil-
dren and infants.5 Most myxomas are idiopathic
in origin, but in approximately 5% of cases the
patient will have a family history of myxomas.1
Generally, the familial form of cardiac myxoma is
associated with Carney’s syndrome, an autosomal
dominant condition that is most common in
younger men (mean age, 25 years) and generally
is accompanied by noncardiac myxomas and ex-
tensive facial freckling.1,6 Most myxomas are
solid tumors that Figure 2. Papillary form of atrial myxoma tumor.

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SURGICAL RESECTION OF ATRIAL MYXOMAS
type of obstruction results in clinical signs similar
to those of mitral valve disease. A mobile tumor
often causes intermittent symptoms that may
change in severity as the patient changes position.
Although atrial myxomas are benign, if they are
left untreated, syncope and even sudden death can
occur if the tumor temporarily occludes the orifice
of the mitral valve and blocks blood flow to the
left ventricle.5 Damage to the leaflets of the mi-
tral valve is possible if a mobile myxoma tumor
rubs against the cusp of the valve; this can neces-
sitate mitral valve repair or replacement at the
time the myxoma is removed.7 Clinical signs of
right atrial myxomas often mimic those of tricus-
pid valve stenosis and right-sided heart failure,
including ascites, peripheral edema, and hepato-
megaly. The onset of clinical symptoms is depen-
dent on the size and location of the tumor.5
Embolic events occur when thrombi on the
surface of the tumor detach to form emboli or
when fragments of tumor tissue break off and
enter the systemic circulation. The majority of
myxoma-related embolic events are cerebrovascu-
lar accidents or transient ischemic attacks as em-
boli pass from the systemic circulation into the
cerebral circulation. Myxoma-related emboli or
tumor fragments also can affect the coronary, reti-
nal, iliac, and femoral arteries.4,5,7
Approximately 50% of patients with a myxoma
will experience systemic symptoms, including
fatigue, weight loss, fever, and joint pain. The
cause of systemic symptoms is not understood
fully but is believed to be an autoimmune re-
sponse related to the presence of the tumor.7
DIAGNOSIS
Manifestations of all cardiac tumors, including
atrial myxomas, are dependent on the location
and size of the tumor. Chest auscultation may
reveal a “tumor plop,” a sound that typically oc-
curs during early diastole and is believed to be
caused by motion of the tumor striking the wall
of the endocardium.5,6 This sound may be mis-
taken for a third heart sound. No specific electro-
www.aornjournal.org
cardiographic changes correlate with the presence
of cardiac tumors, including myxomas. The ma-
jority of patients with atrial myxomas have a nor-
mal chest radiograph, but occasionally there is
visible enlargement of the affected chamber of the
heart. Patients with systemic symptoms may have
abnormal laboratory test results, including leuko-
cytosis, elevated sedimentation rate, and elevated
C-reactive protein level, but these results are sim-
ilar to those for other autoimmune disorders and
do not indicate a positive diagnosis of atrial
myxoma.
Atrial myxomas are most commonly diagnosed
via echocardiography, either transthoracic or
transesophageal, performed as part of a compre-
hensive cardiac evaluation, which allows the car-
diologist to determine the presence, location, size,
and mobility of the tumor. On echocardiographic
examination, tumor mobility generally distin-
guishes myxomas from other types of cardiac
masses.5 Unless there is a suspicion that the pa-
tient may have coronary artery disease, cardiac
catheterization generally is not performed for pa-
tients diagnosed with a suspected atrial myxoma
because there is a risk that tumor fragments will
be embolized.4 Currently, there is no medical
treatment available that will arrest the growth of
cardiac myxomas. Surgery should proceed as
soon as possible after a patient is diagnosed with
a cardiac myxoma because of the potential for
sudden death from obstruction to blood flow
through the mitral valve or a major embolic event
(eg, cerebrovascular accident, myocardial
infarction).5
PREPARATION OF THE OR AND PATIENT
The circulating nurse and scrub person obtain all
equipment, instruments, supplies, and medications
for the procedure and prepare the room and sterile
field for the planned procedure. The circulating
nurse goes to the preoperative holding area to
conduct the preoperative patient assessment. The
nurse introduces herself or himself to the patient
and designated support person and verifies the
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October 2010 Vol 92 No 4
patient’s identity both verbally with the patient and
by checking the patient’s identification bracelet for
the correct name and medical record number. The
circulating nurse verifies the planned surgical proce-
dure with the patient and confirms that the patient’s
understanding of the planned procedure is congruent
with the surgical informed consent, the surgeon’s
progress note, and the surgery schedule. The nurse
reviews the patient’s laboratory results and verifies
that typed and cross-matched blood is available be-
fore the patient is transferred to the OR. The nurse
queries the patient concerning allergies and verifies
that dentures, partial dentures, contact lenses, and
jewelry, including body jewelry, have been removed
before the patient is transferred to the OR. After
gathering needed information from the patient and
chart review, including any special positioning needs
and the presence of any metal implants including
orthopedic prostheses, the circulating nurse formu-
lates an intraoperative plan of care specific to the
patient (Table 1).
In accordance with Surgical Care Improvement
Project guidelines, the preoperative nurse adminis-
ters a preoperative dose of IV antibiotics in the pre-
operative holding area before transfer to the OR.
The nurse coordinates with the anesthesia care pro-
vider to ensure that antibiotic infusion is timed to
occur within 60 minutes of the skin incision time or
within two hours if it is necessary to use vancomy-
cin. Formal venous thromboembolism prophylaxis
(eg, use of sequential compression device boots or
leggings) begins when the patient is transferred to
the cardiothoracic intensive care unit (CICU) be-
cause the patients will be treated with heparin dur-
ing the surgical procedure. If the patient is on beta-
blocker therapy before admission, the patient’s
cardiologist will resume the beta-blocker orders after
surgery (Table 2).
INTRAOPERATIVE PATIENT CARE
The circulating nurse and anesthesia care provider
transfer the patient on a stretcher from the preopera-
tive holding area to the OR and assist the patient in
transferring to the OR bed. After induction of anes-
396 AORN Journal
HILL—CHERRY—MALONEY—MIDYETTE
thesia, the circulating nurse or RN first assistant
(RNFA) inserts a temperature-probe indwelling uri-
nary catheter, and the anesthesia care provider
places a radial arterial line and a central line. A pul-
monary artery catheter may be placed by the anes-
thesia care provider if the surgeon or anesthesia care
provider determines that it is indicated. The circulat-
ing nurse places an electrosurgical unit (ESU) dis-
persive pad over a well-muscled area. The circulat-
ing nurse, anesthesia care provider, and surgeon
place the patient in the supine position with the pa-
tient’s arms placed at his or her sides and the pal-
mar surface of the hands against the patient’s body.
The circulating nurse pads the patient’s arms with
gel pads and tucks them at the patient’s side with
the draw sheet.
After the patient is positioned, the circulating
nurse initiates a time out. All members of the surgi-
cal team participate in a final verification of the pa-
tient’s identity, planned surgical procedure and site,
and availability of blood and any special equipment
and implants that might be needed for the proce-
dure. The circulating nurse performs the surgical
skin preparation, prepping the patient from chin to
knees, with either a chlorhexidine/alcohol solution
or an iodine/alcohol solution, depending on the sur-
geon’s preference, taking care to avoid any pooling
of the prep solution. After the prep solution is dried,
the scrub person, RNFA, and surgeon drape the
patient using sterile towels, a split drape sheet, and
an iodine-impregnated adhesive plastic drape.
SURGICAL PROCEDURE FOR RESECTION
OF LEFT ATRIAL MYXOMA
Using a #10 blade, the surgeon makes a median
sternotomy incision from the supraclavicular notch
to just beyond the xiphoid process. The surgeon
uses the monopolar ESU pencil to dissect through
the subcutaneous tissue to the sternum and to score
down the midline of the sternum. Using an electric-
powered, reciprocating sternal saw, the surgeon per-
forms the sternotomy. The RNFA and surgeon
achieve sternal edge hemostasis using the monopo-
lar ESU pencil and a bone-paste mixture containing
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TABLE 1. Nursing Care Plan for a Patient Undergoing Excision of an Atrial Myxoma

Interim outcome Outcome

Diagnosis Nursing interventions statement statement
Decreased cardiac  Identifies physiologic status  The patient’s vital signs are  The patient’s
output and risk of  Identifies baseline cardiac status within the expected range cardiovascular status
imbalanced fluid  Reports the presence of implantable at discharge from the OR. is maintained at or
volume cardiac devices  The patient’s hemodynamic improved from
 Reports deviation in diagnostic study status is within the expected baseline levels.
results range at transfer to the
 Monitors physiologic parameters postanesthesia care unit.
 Monitors changes in cardiac status  The warmth of the
 Uses monitoring equipment to assess patient’s skin is consistent
cardiac status with adequate perfusion at
 Evaluates cardiac status discharge from the OR.

Risk of impaired skin  Confirms patient identity  The patient’s skin, other  The patient is free from
integrity, risk of  Verifies operative procedure, surgical than surgical incision, signs and symptoms
perioperative site, and laterality remains unchanged of electrical injury.
positioning injury,  Assesses baseline skin condition between admission and  The patient is free from
and risk of injury  Identifies baseline tissue perfusion discharge from the OR or signs and symptoms
 Identifies baseline musculoskeletal status procedure room. of injury related to
 Identifies physical alterations that require  The patient reports positioning.
additional precautions for procedure- comfort at the dispersive  The patient is free from
specific positioning electrode site on unintended retained
 Verifies presence of prosthetics or admission to the foreign objects.
corrective devices postoperative care unit.
 Positions the patient  The patient’s peripheral
 Implements protective measures to tissue perfusion is
prevent skin/tissue injury from consistent with
mechanical sources preoperative status at
 Implements protective measures to discharge from the OR or
prevent injury from electrical sources procedure room.
 Uses supplies and equipment within safe  The patient is free from
parameters pain or numbness
 Applies safety devices associated with surgical
 Evaluates tissue perfusion
positioning.
 Evaluates musculoskeletal status
 The counts are accurate,
 Evaluates for signs and symptoms of
correct, or reconciled
physical injury to skin and tissue
according to facility policy.
 Performs required counts
 Evaluates results of the surgical count

Risk of imbalanced  Assesses risk of inadvertent hypothermia  The patient’s temperature  The patient is at or
body temperature  Assesses risk of inadvertent hyperthermia is greater than 36° C returning to
 Identifies physiologic status (96.8° F) at the time of normothermia at the
 Reports deviation in diagnostic study results discharge from the OR or conclusion of the
 Implements thermoregulation measures procedure room. immediate
 Monitors body temperature postoperative period.
 Monitors physiologic parameters
 Evaluates response to thermoregulation
measures

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TABLE 1. (continued) Nursing Care Plan for a Patient Undergoing Excision of an Atrial Myxoma

Interim outcome
Diagnosis Nursing interventions statement Outcome statement
Acute pain or  Assesses pain control  The patient participates in  The patient or
chronic pain  Identifies cultural and value components management of pain designated support
related to pain control before and person demonstrates
 Includes patient or designated support immediately after surgery. knowledge of pain
person in perioperative teaching  The patient and family management.
 Provides pain management instruction member or support person
 Implements pain guidelines verbalize realistic
 Implements alternative methods of pain expectations regarding
control discomfort after surgery.
 Collaborates in initiating patient-  The patient verbalizes
controlled analgesia the side effects of the
 Evaluates response to pain management analgesic to report to the
interventions health care provider at
the time of discharge.
 The patient accurately
describes the prescribed
regimen for postoperative
pain control at the time of
discharge.

Impaired  Identifies baseline respiratory  The patient is mechanically  The patient’s

spontaneous status ventilated with oxygen respiratory status is
ventilation  Identifies physiologic status therapy through an maintained or
 Reports deviation in diagnostic study endotracheal tube, improved from
results laryngeal airway mask baseline levels.
 Reports deviation in arterial blood gas device, or tracheotomy
studies tube at discharge from the
 Monitors physiologic parameters OR or procedure room.
 Monitors changes in respiratory  The patient’s arterial
status oxygen concentration and
 Uses monitoring equipment to respiratory rate are within
assess respiratory status during the expected range at
transport to the cardiac intensive discharge from the
care unit by postoperative care unit.
 interpreting respiratory monitoring

device readings and recognizing and

reporting abnormal readings;
 monitoring assisted ventilation

parameters as appropriate (ie,

ventilator settings and alarms); and
 ensuring emergency equipment,

medications, and supplies are

available at all times (eg, defibrillator/
monitor, bag-valve mask, emergency
cart)
 Evaluates respiratory status

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SURGICAL RESECTION OF ATRIAL MYXOMAS
TABLE 1. (continued) Nursing Care Plan for a Patient Undergoing Excision of an Atrial Myxoma
Diagnosis Nursing interventions
Risk of infection  Assesses susceptibility for infection
 Classifies the surgical wound
 Implements aseptic technique
 Protects from cross-contamination
 Initiates traffic control
 Administers prescribed prophylactic
treatments
 Administers prescribed medications
 Administers prescribed antibiotic therapy
as ordered
 Administers immunizing agents as
ordered
 Performs skin preparations
 Monitors for signs and symptoms of
infection
 Minimizes the length of the invasive
procedure by planning care
 Maintains continuous surveillance
 Administers care to wound sites
 Administers care to invasive device sites
 Encourages deep breathing and
coughing exercises
 Evaluates factors associated with
increased risk of postoperative infection
at the completion of the procedure
 Evaluates the progress of wound healing
 Evaluates for signs and symptoms of
infection through 30 days after the
perioperative procedure
gelfoam powder, vancomycin, and thrombin. The
surgeon places a self-retaining sternal retractor be-
tween the edges of the sternum. Using DeBakey
forceps and a monopolar ESU pencil, the surgeon
opens the pericardium and secures it to the patient’s
skin with six 2-0 silk stay sutures. To help prevent
portions of the tumor from breaking off and forming
an embolus, the surgeon and RNFA avoid manipu-
lating the heart before initiation of CPB.1
Preparing for CPB
The surgeon places aortic, cardioplegic, superior
vena cava (SVC), and inferior vena cava (IVC)
purse-string sutures to prepare for cannulation. The
anesthesia care provider administers heparin at this
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Interim outcome
statement Outcome statement
 The patient’s wound is free  The patient is free from
from signs or symptoms of signs and symptoms
infection and pain, of infection.
redness, swelling,
drainage, or delayed
healing at the time of
discharge.
 The patient has a clean,
primarily closed surgical
wound covered with a dry,
sterile dressing at
discharge from the OR.
 The patient’s wound is
intact and free from signs
of infection 30 days after
surgery.
 The patient’s immune
status remains within
expected levels 5 days
after surgery.
 The patient is afebrile and
free from signs and
symptoms of infection.
time in preparation for CPB. For the aortic cannula-
tion site, the surgeon places two single-armed, 2-0
braided, polyester purse-string sutures in the ascend-
ing aorta. The RNFA threads the first aortic purse-
string suture through a disposable plastic tourniquet,
secures it with a hemostat, and then secures the sec-
ond aortic purse-string suture with a hemostat. The
surgeon places a double-armed, 3-0 braided, polyes-
ter purse-string suture on the ascending aorta for the
cardioplegia catheter. The RNFA threads the suture
through a disposable tourniquet and secures it with a
hemostat. The surgeon places caval tapes around the
SVC and IVC. Using a kidney-pedicle clamp, the
surgeon places an umbilical tape around the SVC.
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TABLE 2. Surgical Care Improvement Project (SCIP) Guidelines for Adult Cardiac Surgery
Procedures1

SCIP-Inf-1  Prophylactic antibiotics are administered within 1 hour before the skin incision (within 2 hours if vancomycin).
SCIP-Inf-2  Prophylactic antibiotic recommended for the procedure type is administered.
 Recommended antibiotics for cardiac surgery patients:
 First choices: cefazolin, cefuroxime.

 Vancomycin is recommended as an adjuvant therapy to the cephalosporin if the patient is considered to

be at high risk for developing a methicillin-resistant Staphylococcus aureus infection.

2
 Vancomycin is recommended for patients allergic to beta-lactam antibiotics.

SCIP-Inf-3  Prophylactic antibiotics are discontinued within 48 hours after the cardiac surgery procedure.
SCIP-Inf-4  Blood glucose level should be tightly controlled in cardiac surgery patients for the first 48 hours after the
surgical procedure.
 Daily 6 AM target blood glucose ⱕ 200 mg/dL.
SCIP-Inf-6  Hair removal, when necessary, should be performed with clippers.
 Razors should not be used for preoperative hair removal.
SCIP-CARD-2  Patients on beta-blocker therapy before admission continue to receive beta-blocker treatment postoperatively.
SCIP-VTE  Surgery patients will receive appropriate venous thromboembolism prophylaxis.

References
1. Health Services Advisory Group: Patient safety quality measures for the Surgical Care Improvement Project. Quality Net. http://www.qualitynet.org/
dcs/ContentServer?c⫽MQTools&pagename⫽Medqic%2FMQTools%2FToolTemplate&cid⫽1228733278547&parentName⫽Category. Accessed June
19, 2010.
2. Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in
cardiac surgery, part I: duration. Ann Thorac Surg. 2006;81(1):397-404.

The surgeon then places a double-armed, 2-0
braided, polyester purse-string suture in the SVC,
threads it through a disposable tourniquet, and se-
cures the suture with a hemostat. The RNFA threads
the umbilical tape that was placed around the SVC
through a disposable tourniquet and secures the tape
with an intestinal clamp. The surgeon uses a vascu-
lar clamp to place an umbilical tape around the IVC
and places a double-armed, 2-0 braided, polyester
purse-string suture in the lower portion of the right
atrium where it meets the IVC. The RNFA secures
the IVC purse-string suture and the umbilical tape
around the IVC. The RNFA threads the purse-string
suture through a disposable plastic tourniquet and
secures it with a hemostat. When all purse-string
sutures are placed, the surgeon and RNFA clamp
and divide the atrioventricular pump tubing and
place arterial and venous connectors into the tubing.
Cannulation
Arterial cannulation is performed first. Using a #11
blade, the surgeon makes a stab incision in the
aorta. He or she inserts the arterial cannula into the
stab incision and cinches down on the purse-string
suture with the disposable tourniquet, securing it
with a hemostat. The surgeon ties a #2 silk tie
around the aortic cannula and tourniquet and then
attaches the aortic cannula to the CPB tubing. The
surgeon secures the cannula to the drape with a hys-
terectomy clamp. The surgeon cannulates the IVC
by making a stab incision with a #11 blade and then
dilates the stab incision using a Kelly clamp. The
surgeon inserts an appropriately sized, metal-tipped,
right-angle venous cannula into the IVC and tight-
ens the tourniquet using a hemostat and a #2 silk
tie tied around the cannula and tourniquet. The
surgeon cannulates the SVC in the same fashion.
The surgeon attaches both venous cannulas to a
Y-connector that was inserted into the CPB pump
tubing earlier. After making a stab incision in the
aorta with a #11 blade next to the previously placed
cardioplegic purse-string suture, the surgeon inserts
the antegrade cardioplegia catheter into the ascend-
ing aorta, tightens the purse-string suture, and se-
cures the tourniquet with a hemostat. The surgeon

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SURGICAL RESECTION OF ATRIAL MYXOMAS
removes the inner stylet and clamps the catheter
with a Kelly clamp. The RNFA attaches the cardio-
plegia catheter to the cardioplegia line going to the
CPB machine. The surgeon clamps the aorta with a
soft-jawed cross clamp. After CPB has been initi-
ated, the perfusionist cools the patient to 32° C
(89.6° F). The scrub person provides the surgeon
with cold, saline-slush solution to cool the heart.
Procedure
To completely remove the left atrial myxoma, the
surgeon opens both the left and right atrium (ie, a
biatrial approach). The right atrium is opened be-
cause the pedicle stalk of the myxoma is almost
always located on the septum dividing the left and
right atrium. Using a #11 blade and scissors, the
surgeon opens the left atrium and uses a handheld
mitral retractor to retract the left atrium for visual
inspection of the myxoma. The surgeon tightens the
caval tapes around the SVC and IVC and secures
them with an intestinal clamp before opening the
right atrium. Using DeBakey forceps and scissors,
the surgeon opens the right atrium. The surgeon
removes the myxoma using a #15 blade, ensuring
that the specimen with the stalk attached is removed
fully. The scrub person hands off the specimen to
the circulating nurse, who places it in a labeled ster-
ile specimen cup containing saline and sends it to
the pathology laboratory.
Typically, the surgeon closes the defect made in
the septum using an appropriately sized patch har-
vested from the pericardium. Using a 4-0 polypro-
pylene suture, the surgeon sews the pericardial patch
on the defect. The surgeon closes the left atrium
using two single-armed, 3-0 polypropylene sutures
and removes the caval tapes from around the SVC
and IVC. Using a single-armed, 5-0 polypropylene
suture, the surgeon closes the right atrium. The per-
fusionist begins rewarming the patient at this time to
a temperature of 37° C (98.6° F). The surgeon re-
moves the aortic cross clamp and uses the cardiople-
gia catheter as a vent to remove all air from the
heart. The surgeon inserts a left atrial pressure line
for continuous monitoring after surgery by threading
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a polyvinyl catheter into the left atrium. Using a #15
blade, the surgeon makes a stab incision through the
skin and uses a 5-0 silk suture to secure the polyvi-
nyl catheter in place. He or she then threads the
catheter through a 13-gauge needle and attaches it to
a three-way stopcock that connects to an anesthesia
pressure monitoring line. The surgeon secures the
stopcock to the skin using two 0 silk sutures. After
placing two temporary pacing wires on the right
atrium, the surgeon inserts two mediastinal chest
tubes, one 24-Fr angled chest tube and one 28-Fr
straight chest tube.
Discontinuing CPB
When the patient is fully rewarmed, the perfusionist
discontinues CPB. The surgeon decannulates the
SVC first by clamping the SVC cannula using a
pump tubing clamp. He or she uses a #15 knife
blade to release the #2 silk tie around the cannula
and tourniquet. The surgeon removes the tourniquet
from the purse-string suture and removes the can-
nula from the SVC. The surgeon then ties down the
purse-string suture. The surgeon removes the IVC
cannula in the same manner.
When transesophageal echocardiography has con-
firmed removal of all air from the heart, the surgeon
removes the cardioplegia catheter. The surgeon ties
down the purse-string suture and uses a 3-0 poly-
propylene suture with pledget to oversew the car-
dioplegia catheter site. After the anesthesia care
provider has administered protamine to reverse the
heparin, the surgeon removes the aortic cannula.
Depending on the patient’s hemodynamic parame-
ters and laboratory results, the anesthesia care pro-
vider will transfuse the type and cross-matched
blood as needed. The surgeon clamps the aortic can-
nula using a pump tubing clamp. The surgeon cuts
the #2 silk tie around the cannula and tourniquet
using a #15 blade. He or she then removes the
tourniquet around the aortic purse-string suture,
removes the aortic cannula, and ties down the two
aortic purse-string sutures. The surgeon uses a 3-0
polypropylene suture with pledget to oversew the
aortic cannulation site.
AORN Journal 401
October 2010 Vol 92 No 4
Sternotomy Closure
In preparation for closing the sternum, the surgeon
assesses all surgical and cannulation sites. The sur-
geon uses a monopolar ESU pencil and absorbable
gelatin sponges containing thrombin as needed to
ensure adequate hemostasis of the surgical field. The
surgeon removes the sternal retractor and examines
the sternal bone edges and uses the monopolar ESU
pencil to achieve hemostasis around bleeding bone
edges. The surgeon then places the sternal retractor
back into the sternal incision to reassess hemostasis
before completing closure of the sternum. The circu-
lating nurse and scrub person perform a surgical
count at this time.
The surgeon inserts a pain pump catheter on each
side of the sternal incision for postoperative pain
management. The scrub person primes each catheter
with 5 mL of 0.25% bupivacaine and attaches the
catheters to a pain pump containing 0.5% bupiva-
caine at the end of the surgical procedure. The pre-
filled, self-contained, 270-mL elastomeric pain
pump distributes a continuous infusion of local an-
esthetic into the subcutaneous tissue surrounding the
surgical site. The surgeon secures the catheters to
the skin using 0 silk sutures. He or she closes the
sternum using #7 stainless steel wires. The circulat-
ing nurse and scrub person perform the final surgi-
cal counts at this time.
The circulating nurse connects the two mediasti-
nal chest tubes to a closed, chest-drainage system.
Using two 0 polyglactin sutures, the surgeon closes
the subcutaneous tissue layer and then uses two 3-0
polydioxanone sutures to close the subcuticular tis-
sue layer. The scrub person places a sterile dressing
over the incision, and the circulating nurse secures it
with tape.
TRANSITION FROM THE OR TO THE
POSTOPERATIVE CICU
The anesthesia care provider, circulating nurse,
RNFA, and perfusionist transfer the patient to the
CICU. Structured and detailed hand-off communica-
tion between the OR and the CICU teams is critical
to ensure the delivery of an individualized plan of
402 AORN Journal
HILL—CHERRY—MALONEY—MIDYETTE
care in the initial recovery phase. The anesthesia
care provider gives the receiving nurse information
about the patient’s current ventilator settings, hemo-
dynamic status, all drips and medications the patient
has received as well as those he or she will be re-
ceiving in the immediate postoperative period, and
any other data the anesthesia care provider considers
relevant to the postoperative care of the patient (eg,
whether the patient had a difficult airway). The cir-
culating nurse provides the receiving CICU nurse
with a detailed description of the number and loca-
tion of dressings, chest tubes, and other drains; the
patient’s allergy status; and any other special con-
cerns (eg, patient does not speak English, family
concerns). The anesthesia care provider continually
monitors the patient until the patient is stable and
hand-off is complete. Optimal outcomes for the pa-
tient after excision of atrial myxoma can be
achieved with this multidisciplinary approach.
SURGICAL OUTCOMES
The outcomes achieved for the patient during the
first 24 hours after surgery affect the total course of
the patient’s hospital stay. The patient’s desired out-
comes for this period include
 stabilized hemodynamics with normal cardiac
output on minimal isotropic support,
 extubation within six hours after surgery,
 controlled heart rate and rhythm,
 absence of active bleeding,
 normal neuromuscular responses,
 renal function at preoperative baseline levels,
and
 laboratory results within normal limits.
POTENTIAL POSTOPERATIVE
COMPLICATIONS OF CPB
Delivery of care is tailored to manage individual
patient responses to the physiologic effects of CPB
and induced hypothermia. Cardiopulmonary bypass
activates a systemic inflammatory response syn-
drome characterized primarily by cardiovascular and
pulmonary alterations; however, any organ system
can be affected. This process is triggered mainly by
SURGICAL RESECTION OF ATRIAL MYXOMAS
 the blood coming in contact with the artificial
surfaces of the extracorporeal circuit,
 hypoperfusion and ischemia to major organs,
and
8 cations resulting from CPB. The longer the patient
 endotoxin release from the gut.
The risk of decreased cerebral perfusion and the
potential for air microemboli are always present
during CPB. The systemic inflammatory response
syndrome triggers an endogenous catecholamine
release that increases systemic vascular resistance.
Myocardial depression or stunning (ie, a tempo-
rary reduction in the performance of myocardial
tissue after a period of reduced cardiac perfusion)
can be caused by induced hypothermia and pro-
longed CPB and is exacerbated by preexisting heart
disease. Some degree of reduced cardiac output is
often evident during the immediate postoperative
period. As a result of hypoinflation of the lungs dur-
ing the surgical procedure, atelectasis and pulmo-
nary congestion are evident to varying degrees in
the postoperative period.8
Before the procedure, the perfusionist primes the
CPB circuitry with crystalloid fluids, decreasing
plasma proteins through the hemodilution process,
but this can result in interstitial fluid shifting (eg,
third spacing). As a result of third spacing, the pa-
tient experiences postoperative diuresis, which can
contribute to hypokalemia and hypomagnesemia.
Coagulopathies can result from a variety of
factors. For instance, coagulopathies may result
from
 systemic heparinization caused by inadequate
protamine reversal after rewarming (ie, heparin
rebound);
 mechanical trauma to platelets by CPB;
 transfusion of fibrin and thrombocyte-depleted
volume expanders; and
 decreased clotting factor production in response
to hypothermia.
Hyperglycemia secondary to glycogenolysis and
inhibited insulin release is managed with insulin
infusions. Tight glucose control is important because
www.aornjournal.org
if the patient goes into a hyperglycemic state, the
patient’s risk for postoperative infections increases.
Postoperative medical management and nursing
care is focused on preventing and managing compli-
is on CPB, the greater the potential for and extent of
the complications.8
POSTOPERATIVE CARE SPECIFIC TO
ATRIAL MYXOMA SURGERY
Cardiovascular function is optimized by managing
the components of cardiac output. Systemic vascular
resistance (ie, afterload), volume status (ie, preload),
myocardial contractility, and heart rate and rhythm
are monitored and managed continuously the day of
surgery. This is accomplished using data from arte-
rial, pulmonary artery, and central venous catheters,
as well as continuous cardiac output measurements
and electrocardiography. The surgeon may place
a direct, left atrial catheter if needed for a more
accurate reflection of left ventricular end diastolic
volume.
Atrial dysrhythmias are common after all cardiac
surgeries, including atrial myxoma removal. Resec-
tion of the myxoma from the atrial septum often
requires a pericardial patch to close the septal exci-
sion of the tumor. With this manipulation there is
the greater potential for atrial dysrhythmias and
heart blocks. Bateman and colleagues9 reported that
dysrhythmias can be caused by trauma incurred by
the conduction tissue during myxoma removal and
atrial distention during the biatrial approach. Gat-
zoulis et al10 demonstrated that age older than 40
years at the time of surgery is a predictor of late
postoperative atrial fibrillation, atrial flutter, and
junctional rhythm. In a study by Grande et al,11
25.8% of patients developed postoperative atrial
fibrillation after cardiac tumor removal.
Atrial myxomas can cause postoperative throm-
boembolic events. Fragments of the myxoma may
dislodge and travel to arteries downstream. Blood
clots also can form on the myxoma and release at
the time of surgery. Pulmonary emboli and pulmo-
nary hypertension may result from a right atrial
AORN Journal 403
October 2010 Vol 92 No 4 HILL—CHERRY—MALONEY—MIDYETTE

PATIENT EDUCATION
Atrial Myxoma Excision
What is an atrial myxoma?  Wash your incision each day with a mild perfume-free
An atrial myxoma is a rare noncancerous tumor that grows soap and gently pat dry; do not put any lotion or powder
in one of the atrial chambers of the heart. Often, these tu- directly on the incision until it is completely healed.
mors are attached to the wall of the heart by a stalk, which  You may also want to listen to music, hold a pillow
may allow the tumor to move when you change positions. against you chest when coughing, and use ice packs on
your incision.
What are the signs and symptoms of atrial
 Talk to your surgeon or pharmacist before taking any
myxoma?
over-the-counter medications.
People with an atrial myxoma may experience shortness of
 Do not lift, push, or pull anything heavier than 5 lb for
breath with activity, dizziness, fatigue, and palpitations
the first two weeks after surgery.
(feeling like your heart is “racing”).
 Do not lift, push, or pull anything heavier than 20 lb for
How is atrial myxoma diagnosed? three months after surgery.
Your health care provider may hear an extra heart sound (a  Make an appointment with your
“tumor plop”) caused by movement of the myxoma. The  surgeon for 2 and 6 weeks after surgery, and
most effective way to diagnose this condition is an echo-  cardiologist for 3 months after surgery.
cardiogram (ultrasound) of your heart.  Your surgeon or cardiologist may send you to cardiac
What are my treatment options? rehabilitation to help you recover from surgery.
At this time, surgical removal is the only treatment for When should I call my doctor?
atrial myxoma. There is no medicine available that will Call your doctor immediately if you
stop the growth or shrink the size of the tumor. Surgery  are short of breath or suddenly feel dizzy or weak;
should be scheduled as soon as possible after diagnosis  notice increased redness, swelling, or drainage at your
because it is possible for the tumor to partially or com- surgical incision site;
pletely block the flow of blood through your heart.  have fever greater than 38.3° C (101° F) or chills;
 have nausea or vomiting that is not relieved with medi-
What will the preoperative care include?
cation; or
 Do not eat or drink anything after midnight the night  have pain that is not controlled with the pain medicine
before your surgery. ordered by your doctor.
 Ask your doctor whether you should take your current
Resources
medications the morning of surgery.
1. Atrial myxoma. How Stuff Works. http://healthguide
 After being admitted to the preoperative holdings area, a
.howstuffworks.com/atrial-myxoma-dictionary.htm. Ac-
nurse will measure your vital signs and ask questions
cessed June 20, 2010.
about your health history and current health status.
2. Atrial myxoma. Medline Plus Medical Encyclopedia.
 An anesthesia care provider will talk to you about the
http://www.nlm.nih.gov/medlineplus/ency/article/
type of anesthesia you will receive to keep you asleep
007273.htm. Accessed June 20, 2010.
and pain free during surgery. Let your health care pro-
vider know if you have any questions.
What will postoperative care include?
 Immediately after surgery, you will be admitted to the
cardiovascular intensive care unit (CICU), where you
will be monitored closely for a day or two.
 You will then be transferred to the cardiac step-down
unit where you will stay until you are ready to be dis-
charged home. It is very important to breathe deeply us-
ing an incentive spirometer to prevent pneumonia after
surgery.
 While you are recovering from surgery, you may feel
tired or uncomfortable. Your nurse will work with you to
evaluate and treat your pain. Your nurse can also give
you medicine for nausea, if needed.
What happens after I go home?
 Eat a healthy diet and stay as active as your energy and
pain permit; plan rest into your daily schedule. Illustration courtesy of Steven P. Goldberg, MD.

404 AORN Journal

SURGICAL RESECTION OF ATRIAL MYXOMAS
myxoma. Pulmonary artery pressure monitoring will
help detect pulmonary hypertension. Cerebral throm-
botic events are a potential complication if the tu-
mor fragment or clot originates in the left atrium.
Patient care includes detailed assessment of strength
and movement in all extremities, pupillary size
and reaction, and appropriateness of response to
commands.
DISCHARGE
Typically, all invasive monitoring lines are removed
on postoperative day one, and the patient is trans-
ferred to a telemetry unit. Early, frequent ambula-
tion and aggressive pulmonary toilet are necessary
to achieve the desired outcome of discharge on post-
operative day five. The postoperative nurse encour-
ages the patient to gradually increase activity each
day while monitoring the patient for the develop-
ment of atrial dysrhythmias or cardiopulmonary
dysfunction.
Preparation for discharge begins in the preopera-
tive period. Nursing staff members involve the pa-
tient and family members during discharge instruc-
tion, which includes information on
 activity restrictions,
 diet,
 pain control,
 home medications,
 signs and symptoms to report to the surgeon,
and
 follow-up care.
If the patient’s nurse or surgeon is concerned that
the patient might have inadequate postoperative
family support after discharge, a hospital social
worker evaluates the patient and family to determine
whether postdischarge home health visits will be
needed. Before discharge, the patient’s nurse pro-
vides oral and written discharge instructions that
include instructing the patient
 to slowly increase activity as tolerated while
avoiding any vigorous activity for 12 weeks af-
ter surgery;
www.aornjournal.org
 not to lift anything heavier than 5 lb in the first
two weeks after discharge and nothing heavier
than 20 lb for three months after surgery;
 to wash the incision site with a mild soap daily
and pat the site completely dry; and
 to notify the surgeon’s office if the patient expe-
riences
 a fever greater than 38.3° C (101° F),
 chills, or
 increased redness, tenderness, or drainage
from the incision site.
The nurse also instructs the patient to make follow-
up appointments with the surgeon at two weeks and
six weeks after surgery and with his or her cardiolo-
gist at three months postdischarge. The surgeon or
cardiologist refers the patient to a cardiac rehabilita-
tion program if he or she believes the patient will
benefit from a supervised exercise program.
EXPECTED OUTCOMES AND
FOLLOW-UP CARE
Expected outcomes for patients after surgical resec-
tion of an atrial myxoma are that the patient will
gradually return to his or her preoperative level of
physical activity and be fully able to resume usual
activities no later than the 12th postoperative week.
Follow-up care includes a three-month postoperative
cardiology appointment in which the patient under-
goes an echocardiographic examination that will
allow the cardiologist to evaluate cardiac function
and to verify that there is no regrowth of the tumor
at the surgical resection site. Patients continue to
follow-up with their cardiologists for an echocardio-
graphic screening examination annually. Tumor re-
currence in patients with sporadic myxoma tumors
is uncommon provided that all tumor tissue is re-
moved at the time of surgery. Recurrence can be a
result of inadequate resection, intraoperative implan-
tation, and embolization of tumor fragments.12,13
Outcomes after surgical removal of sporadic atrial
myxoma generally are excellent, with no long-
term sequelae as a consequence of the tumor or
surgical procedure.4
AORN Journal 405
October 2010 Vol 92 No 4
Acknowledgement: The authors thank David C.
McGiffin, MD, professor of cardiovascular and
thoracic surgery at the University of Alabama at
Birmingham, for his assistance with the prepara-
tion of this manuscript.
References
1. Roberts W. Cardiac neoplasms. In: Topol E, ed. Text-
book of Cardiovascular Medicine. 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2002:917-922.
2. Murphy D, Miller J, Langford D. Robot-assisted endo-
scopic excision of left atrial myxomas. J Thorac Car-
diovasc Surg. 2005;130(2):596-597.
3. Shapiro L. Cardiac tumours: diagnosis and manage-
ment. Heart. 2001;85(2):218-222.
4. Finkelmeier B. Other cardiovascular disorders. In: Car-
diothoracic Surgical Nursing. 2nd ed. Philadelphia, PA:
Lippincott; 2000:77-83.
5. Reardon M, Smythe W. Cardiac neoplasms. In: Cohn L,
Edmunds L, eds. Cardiac Surgery in the Adult. 2nd ed.
New York, NY: McGraw-Hill; 2003:1479-1510.
6. Kouchoukos N, Blackstone E, Doty D, Hanley F, Karp R.
Cardiac tumors. In: Kirklin/Barratt-Boyes Cardiac Sur-
gery: Morphology, Diagnostic Criteria, Natural History,
Techniques, Results and Indications. 3rd ed. London, En-
gland: Churchill Livingstone; 2003:1679-1688.
7. Roschkov S, Rebeyka D, Mah J, Urquhart G. The dan-
gers of cardiac myxomas. Prog Cardiovasc Nurs. 2007;
22(1):27-30.
8. Hall RI, Smith MS, Rocker G. The systemic inflamma-
tory response to cardiopulmonary bypass: pathophysio-
logical, therapeutic, and pharmacological consider-
ations. Anesth Analg. 1997;85(4):766-782.
9. Bateman TM, Gray RJ, Raymond MJ, Chaux A, Czer
LS, Matloff JM. Arrhythmias and conduction distur-
bances following cardiac operation for removal of left
atrial myxomas. J Thorac Cardiovasc Surg. 1983;86(4):
601-607.
10. Gatzoulis M, Freeman M, Siu SC, Webb GD, Harris L.
Atrial arrhythmia after surgical closure of atrial septal
defects in adults. N Engl J Med. 1999;340(11):839-846.
11. Grande AM, Ragine T, Jill JD. Primary cardiac tumors:
a clinical experience of 12 years. Tex Heart Inst J.
1993;20(3):223-230.
406 AORN Journal
HILL—CHERRY—MALONEY—MIDYETTE
12. Gerbode F, Kerth WJ. Surgical management of tumors
of the heart. Surgery. 1967;61(1):94-101.
13. Pinede L, Duhaut P, Loire R. Clinical presentation of
left atrial myxoma. A series of 112 consecutive cases.
Medicine (Baltimore). 2001;80(3):159-172.
Resource
1. Aldea GS, Verrier ED. Cardiac tumors. In: Gardner T,
Spray T, eds. Operative Cardiac Surgery. 5th ed. Lon-
don, England: A Hodder Arnold Publication; 2004:525-
532.
Marites Hill, RN, BSN, is a CVOR nurse clinician
at UAB Hospital, Birmingham, AL. Ms Hill has no
declared affiliation that could be perceived as pos-
ing a potential conflict of interest in the publication
of this article.
Cecile Cherry, RN, MSN, CNOR, is an advanced
nursing coordinator for Perioperative Services at
UAB Hospital, Birmingham, AL. Ms Cherry has no
declared affiliation that could be perceived as pos-
ing a potential conflict of interest in the publication
of this article.
Martin Maloney, RN, BSN, is a nurse manager in
the Cardiothoracic Intensive Care Unit at UAB
Hospital, Birmingham, AL. Mr Maloney has no
declared affiliation that could be perceived as pos-
ing a potential conflict of interest in the publication
of this article.
Paula Midyette, RN, MSN, CCRN, CCNS, is an
advanced nursing coordinator in the Cardiothoracic
Intensive Care Unit at UAB Hospital, Birmingham,
AL. Ms Midyette has no declared affiliation that
could be perceived as posing a potential conflict of
interest in the publication of this article.
EXAMINATION
CONTINUING EDUCATION PROGRAM

3.3
Surgical Resection of www.aorn.org/CE

Atrial Myxomas

PURPOSE/GOAL
To educate perioperative nurses about care of the patient undergoing surgical
resection of an atrial myxoma.

OBJECTIVES
1. Describe myxomas.
2. Identify symptoms of an atrial myxoma.
3. Explain how atrial myxomas are diagnosed.
4. Discuss the surgical procedure to remove an atrial myxoma.
5. Discuss nursing care of the patient who has undergone surgical excision of an
atrial myxoma.
The Examination and Learner Evaluation are printed here for your conve-
nience. To receive continuing education credit, you must complete the Exami-
nation and Learner Evaluation online at http://www.aorn.org/CE.

QUESTIONS c. systemic symptoms.

1. Myxomas d. tumor-related embolic events.
1. are the most common type of primary cardiac
tumor. 3. Atrial myxomas are malignant, so if they are left
2. may have a pedicle attachment to the endocar- untreated, syncope and even sudden death can
dium that may allow mobility of the tumor. occur.
3. occur more often in men than in women. a. true b. false
4. may originate in the intra-atrial septum with
the body of the tumor extending into the intra- 4. The majority of myxoma-related embolic events
cardiac chamber. are
5. often affect children and infants. 1. cerebrovascular accidents.
a. 1, 2, and 4 b. 1, 3, and 5 2. myocardial infarctions.
c. 1, 2, 4, and 5 d. 1, 2, 3, 4, and 5 3. transient ischemic attacks.
a. 1 and 2 b. 2 and 3
2. The most common presenting symptoms of an c. 1 and 3 d. 1, 2, and 3
atrial myxoma are caused by
a. morbid obesity. 5. Atrial myxomas are most commonly diagnosed
b. obstructed cardiac blood flow. via

© AORN, Inc, 2010 October 2010 Vol 92 No 4 ● AORN Journal 407

October 2010 Vol 92 No 4 CE EXAMINATION

a. cardiac catheterization. lating nurse provides the receiving nurse with

b. chest auscultation. information about
c. chest radiograph. 1. all drips and medications the patient has re-
d. echocardiography. ceived and will be receiving in the immediate
e. electrocardiography. postoperative period.
2. the patient’s allergies.
6. After cardiopulmonary bypass has been initiated, 3. the number and location of chest tubes and
the perfusionist cools the patient to other drains.
a. 32° C (89.6° F). 4. the number and location of dressings.
b. 33° C (91.4° F). 5. the patient’s current ventilator settings.
c. 34° C (93.2° F). 6. whether the patient had a difficult airway.
d. 35° C (95° F). a. 1, 5, and 6 b. 2, 3, and 4
c. 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6
7. The pedicle stalk of the myxoma is almost al-
ways located on the septum dividing the left and 10. The nurse preparing the patient for discharge in-
right atrium. structs the patient to
a. true b. false 1. talk to his or her surgeon or pharmacist before
taking any over-the-counter medications.
8. After removing the myxoma, the surgeon typi- 2. avoid lifting, pushing, or pulling anything
cally closes the defect made in the septum with heavier than 5 lb for the first two weeks after
a. a saphenous vein graft. surgery.
b. an internal mammary artery graft. 3. eat a healthy diet and stay as active as energy
c. a patch harvested from the pericardium. and pain permit.
d. an artificial expanded polytetrafluoroethylene 4. plan rest into his or her daily schedule.
graft. 5. wash the incision each day with a mild
perfume-free soap and gently pat dry.
9. During the hand-off communication between the a. 1 and 3 b. 2, 4, and 5
OR and the intensive care unit teams, the circu- c. 1, 3, 4, and 5 d. 1, 2, 3, 4, and 5

The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor,
with consultation from Susan Bakewell, RN, MS, BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell
have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article.

408 AORN Journal

LEARNER EVALUATION
CONTINUING EDUCATION PROGRAM

3.3
Surgical Resection of www.aorn.org/CE

Atrial Myxomas

T
his evaluation is used to determine the extent to 9. Will you change your practice as a result of
which this continuing education program met reading this article? (If yes, answer question
your learning needs. Rate the items as described #9A. If no, answer question #9B.)
below. 9A. How will you change your practice? (Select all
that apply)
1. I will provide education to my team regard-
OBJECTIVES ing why change is needed.
To what extent were the following objectives of this 2. I will work with management to change/im-
continuing education program achieved? plement a policy and procedure.
1. Describe myxomas. 3. I will plan an informational meeting with
Low 1. 2. 3. 4. 5. High physicians to seek their input and acceptance
2. Identify symptoms of an atrial myxoma. of the need for change.
Low 1. 2. 3. 4. 5. High 4. I will implement change and evaluate the
3. Explain how atrial myxomas are diagnosed. effect of the change at regular intervals until
Low 1. 2. 3. 4. 5. High the change is incorporated as best practice.
4. Discuss the surgical procedure to remove an 5. Other:
atrial myxoma. Low 1. 2. 3. 4. 5. High
5. Discuss nursing care of the patient who has un- 9B. If you will not change your practice as a result
dergone surgical excision of an atrial myxoma. of reading this article, why? (Select all that
Low 1. 2. 3. 4. 5. High apply)
1. The content of the article is not relevant to
my practice.
CONTENT 2. I do not have enough time to teach others
6. To what extent did this article increase your about the purpose of the needed change.
knowledge of the subject matter? 3. I do not have management support to make a
Low 1. 2. 3. 4. 5. High change.
7. To what extent were your individual objectives 4. Other:
met? Low 1. 2. 3. 4. 5. High
8. Will you be able to use the information from 10. Our accrediting body requires that we verify the
this article in your work setting? time you needed to complete the 3.3 continuing
1. Yes 2. No education contact hour (198-minute) program:

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.
AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentialing Center
approves or endorses products mentioned in the activity.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this
activity for relicensure.

Event: #10270; Session: #4025 Fee: Members $16.50, Nonmembers $33

The deadline for this program is October 31, 2013.
A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answers. Each
applicant who successfully completes this program can immediately print a certificate of completion.

© AORN, Inc, 2010 October 2010 Vol 92 No 4 ● AORN Journal 409