Combined operation for left atrial myxoma, mitral regurgitation, coronary artery stenosis and abdominal aortic aneurysm

A 68-year-old male patient with a left atrial myxoma, mitral regurgitation, ischemic heart disease and abdominal aortic aneurysm underwent resection of the myxoma, mitral valve replacement, 4 coronary artery bypass grafting and replacement of the aneurysm simultaneously. The aneurysm was replaced under partial cardiopulmonary bypass. Combined cardiac and abdominal aortic operation is useful in selected patients who require IABP support postoperatively or whose cardiac function is poor.     

Left atrial myxoma combined with coronary artery bypass grafting

We experienced 2 cases of surgical treatment for left atrial myxoma combined with coronary artery bypass grafting (CABG) using only in situ arterial grafts. A 58-year-old man who had undergone CABG [left internal thoracic artery (LITA)-right coronary artery (RCA) and saphenous vein graft (SVG)-left anterior descending artery (LAD)] 14 years before was admitted to our hospital, complaining of anterior chest pain. Coronary arteriography demonstrated total occlusion of the LAD and RCA, as well as the stenosis of high lateral branch (HL) and SVG. Left atrial myxoma was incidentally detected by echocardiography. Myxoma was resected at first, and then the right internal thoracic artery (RITA) was anastomosed to the LAD. The postoperative course was uneventful. A 69-year-old woman was admitted to another hospital, complaining of chest pain and dyspnea. Coronary arteriography revealed stenosis of LAD, left circumflex artery (LCx) and HL, as well as left main trunk (LMT). Left atrial myxoma was incidentally detected by echocardiography. Myxoma was resected at first, and then CABG [LITA-HL, gastroepiploic artery (GEA)-RCA and RITA-LAD] was carried out. The postoperative course was uneventful. The priority between CABG and the surgical treatment for cardiac myxoma remains controversial from the point of view of myocardial protection and prevention of systemic embolism of myxomal fragment.     

Pediatric left atrial myxoma: surgical excision and mitral valve plasty.

This report describes the case of a 12-year-old girl with a giant left atrial myxoma who presented with severe mitral regurgitation symptoms. Echocardiography demonstrated a 69 x 30 mm solid mass in the left atrium (LA), occupying almost the entire mitral orifice. After successful surgical excision of the tumor, concomitant with mitral valve plasty, there was no clinical or echocardiographic recurrence at 12-month follow-up.     

Sinoatrial nodal artery to right atrium fistula after myxoma excision

Acquired coronary artery to cardiac chamber fistulas are rare. Angiographically detectable neovascularization associated with a cardiac myxoma occurs frequently. These vessels are incorporated into the atrial suture line during surgical excision. We describe the case of a patient with a symptomatic right coronary artery to right atrial fistula that had occurred 4 years after left atrial myxoma resection. These large vessels should be considered for ligation during the myxoma resection.     

A giant left atrial myxoma with severe mitral valve regurgitation: report of a case

A 76-year-old female underwent operation with a diagnosis of a left atrial myxoma with accompanied mitral regurgitation. Although no clinical findings of mitral regurgitation were noticed preoperatively, degenerative changes to the anterior leaflet as well as chordae tendinae possibly due to mechanical damage by the movement of the giant tumor through the mitral valve complex were observed in operation. Resection of the tumor and mitral valve replacement were successfully performed. Our case suggests that it is indispensable to investigate the mitral valve during operation even in case of the left atrial tumor with no preoperative findings of mitral regurgitation.     

Giant left atrial myxoma in a patient with mitral insufficiency: case report

We describe a 57-year-old female patient with left atrial giant myxoma and peroperative defined mitral insufficiency who underwent surgery with a diagnosis of a left atrial myxoma without accompanying mitral insufficiency. Although no clinical findings of mitral insufficiency were noticed preoperatively, after myxoma resection moderate mitral insufficiency was observed during surgery. Mitral insufficiency was repaired with annuloplasty. The patient recovered without complication.     

Huge left atrial myxoma masking the severity of mitral regurgitation; report of a case

It is well known that mobile or large left atrial myxoma may lead to valve obstruction and insufficiency, and affect transmitral valve flow. A 50-year-old woman with a huge left atrial myxoma occluding the mitral valve was reported. The tumor was diagnosed by preoperative echocardiogram and mitral regurgitation was minimum. During the operation and after the myxoma resection, a severe mitral regurgitation, which was not observed during the preoperative echocardiogram, was noticed. Mitral valve defect was corrected by an annuloplasty ring, and the patient had an uneventful recovery. Our case suggests that careful evaluation of mitral valve during a myxoma resection operation is recommended.     

Pulmonary artery to left atrial fistula.

A patient with type I right pulmonary artery to left atrial fistula is being presented. He had cyanosis with no precordial findings. Diagnosis was made by transoesophageal echocardiography. Simple ligation of the fistula without cardiopulmonary bypass resulted in complete cure. Early operation to prevent complications is highlighted. Transoesophageal findings of the lesion have not been reported in literature.     

Infected left atrial myxoma with mitral valve endocarditis

We report a rare case of infected left atrial myxoma associated with mitral valve endocarditis. The tumor and a small amount of vegetative growth on the anterior mitral leaflet were surgically excised. Subsequent antibiotic therapy may have prevented the infection from recurring. Histological findings showed myxoma cells embedded in mucinous stroma at the tumor base and an organized thrombus with bacterial colonization at the tumor tip.     

Cryosurgery for left atrial myxoma with coronary artery bypass grafting]

This is the first report of cryoblasion of atrial myxoma which was performed in conjunction with coronary artery bypass grafting. A 63-year-old man was admitted for left atrial tumor and ischemic heart disease. Following coronary artery bypass grafting and resection of left atrial myxoma, cryosurgery was carried out for the residual tumor on atrial septum and left atrial posterior wall. Ultrasonic cardiogram after 1 year revealed no signs of recurrence. Cryoablasion was effective in preventing the recurrence of atrial myxoma.     

Left atrial myxoma causing mitral insufficiency. Report of a case treated with mitral valve replacement.

A case of left atrial myxoma causing mitral insufficiency treated with valve replacement and diagnosed preoperatively as mitral stenosis is presented. The presence of mitral regurgitation is very rare in atrial myxomas and requires mitral valve replacement. In our case mitral regurgitaion was due to the mechanical trauma of the valve by the tumor mass because the patient had no history of rheumatic fever and the pathologic examination of the valve displayed neither rheumatic nor myxomatous degeneration.     

Unusually large left atrial myxoma causing mitral valve occlusion and hiding a severe mitral regurgitation: a case report

We report a case of a 68-year-old woman with a large left atrial myxoma occluding the mitral valve. The tumor was diagnosed by preoperative echocardiogram. During the operation and after the myxoma resection, a severe mitral valve regurgitation, which was not observed during the preoperative echocardiogram, was noticed. Mitral valve defect was corrected by an annuloplasty ring, and the patient had an uneventful recovery. Careful evaluation of the mitral valve during a myxoma resection operation is recommended.     

Role of intraoperative transesophageal echocardiography in detecting masked mitral regurgitation during left atrial myxoma surgery

Myxomas are the most common type of cardiac tumor. Mobile or large left atrial (LA) myxomas frequently cause functional mitral stenosis, and can lead to mitral regurgitation (MR). Difficulties have been associated with detecting masked MR jets and evaluating the severity of MR during LA myxoma surgery due to the presence of a prolapsing tumor and changes in blood flow. We herein presented a case of LA myxoma with significant MR diagnosed on intraoperative transesophageal echocardiography (TEE) prior to cardiopulmonary bypass. Repeated careful observations on TEE led to a confident diagnosis of MR and the selection of an additional appropriate procedure. This case study highlighted the importance of intraoperative TEE in supporting clinical decision-making for optimal mitral valve procedures during LA myxoma surgery.