Left atrial myxoma associated with acute myocardial infarction

A 38-year-old male was admitted to our institution with left atrial myxoma complicated with acute myocardial infarction. The patient had no risk factor for coronary artery disease. A transthoracic echocardiographic study revealed the presence in the left atrium of an echogenic, mobile mass, compatible with myxoma. There were no endocrine hyperactivity, any other tumor and family history. Coronary angiography revealed normal coronary arteries and aorto-coronary bypass surgery was not required in this patient. The tumor was successfully removed surgically. In conclusion, there could be no other etiologic possibility identified and therefore left atrial tumor causing coronary embolization and MI was considered the most likely event in this patient.     

Thrombolysis and embolectomy in treatment of acute stroke as a bridge to open-heart resection of giant cardiac myxoma: A case report

BACKGROUNDCardiac embolism is a common cause of ischemic stroke in young adults. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Early complete resection of giant cardiac myxoma is the key to its treatment and prevention of stroke recurrence.CASE SUMMARYA 42-year-old, previously healthy woman was admitted to the hospital with sudden-onset inability to speak and right-sided hemiplegia. While sweeping the floor 2 h prior to hospital admission, the patient developed sudden inability to express herself or understand what others were saying, accompanied by dyskinesia of the right limb, inability to walk or hold objects, and involuntary choreiform movements of the left upper limb. The patient was diagnosed with cerebral embolism and cardiac myxoma, complicated by left middle cerebral artery occlusion. The acute stroke was treated with intravenous thrombolytic therapy and arterial embolectomy as a bridging therapy to open resection of left atrial cardiac myxoma. The patient condition improved remarkably following initial thrombolysis and embolectomy and subsequently underwent emergency open resection of the atrial cardiac myxoma. She had no recurrence during 1-year follow-up.CONCLUSIONStrong consideration should be given to urgent intravenous thrombolysis (rt-PA, alteplase) in young adult stroke patients at the time of hospital admission. The present case demonstrated a highly successful outcome that combined thrombolysis and arterial embolus retrieval as a bridge to early complete resection of a giant cardiac myxoma for both stroke treatment and recurrence prevention.     

Left atrial myxoma and atrial septal defect with recurrent pulmonary emboli

We have reported a case of left atrial myxoma in association with an atrial septal defect in a patient followed up over a number of years for recurrent sterile pleural effusions and chronic obstructive lung disease of undetermined cause. During hospitalization for pneumonia, an intracardiac mass and atrial septal defect were found by echocardiography, and verified at operation to be a left atrial myxoma.     

Left atrial myxoma mimicking papillary fibroelastoma

A 67-year-old woman was referred to our hospital with a diagnosis of deep vein thrombosis due to surgery for left patellar fracture. Deep vein thrombosis resolved with thrombolytic therapy. Transthoracic echocardiogram revealed a mobile left atrial tumor. Transesophageal echocardiography showed a fragile tumor with multiple fronds, implying a papillary fibroelastoma. Because this patient had a history of cerebral embolism, urgent surgery was scheduled. The excised tumor showed a sea anemone-like appearance in saline, which was similar to that of a papillary fibroelastoma. However, histological examination revealed the features of a myxoma and not papillary fibroelastoma. Herein, we illustrate a very rare case of left atrial myxoma with papillary fibroelastoma-like features in terms of both echocardiographic and gross findings.     

Left atrial myxoma prolapsing into the left ventricle. Case report and review of the literature

Cardiac myxomas are rare tumors which may present differently. Left atrial myxoma is an entity from anatomopathological and clinical aspects. To the best of our knowledge, only 2 cases of infected left atrial myxomas treated surgically have been reported in the last 6 years. Herein, we present a patient with a left atrial myxoma prolapsing into the left ventricle in the diastolic phase, which was infected with Streptococcus viridans. Combined therapy, consisting of surgical management and antimicrobial therapy, was used. Clinical presentation, diagnosis and treatment are reviewed.     

Multicentric cardiac myxoma treated with extended surgery

We present the case of a 37-year-old male patient with a multicentric myxoma admitted to hospital with dyspnoea, syncope and chest pain. Physical examination revealed a grade 3/6 systolic murmur at the left lower sternal border and diffuse bilateral lung rales. Transthoracic echocardiography and thoraco-abdominal computed tomography revealed a right atrial mass and a right ventricular mass obstructing the outflow tract. The patient underwent urgent surgical treatment. At operation, a solitary right atrial myxoma and a right ventricular myxoma originating from the tricuspid valve and attached to the free wall of the right ventricle were seen. The tumours were successfully excised and the tricuspid valve was replaced with a No. 33 Omnicarbon metallic valve. The right ventricular free wall was repaired with a glutaraldehyde-treated pericardial patch. Histopathological examination of the tumours confirmed the diagnosis of myxoma. Post-operative recovery was uneventful and there was no recurrence after 1 year's follow-up.     

Transesophageal echocardiographic diagnosis of left atrial mass as thrombus by demonstrating its attachment to the patch closing atrial septal defect: a case report.

A 65-year-old-man was referred for echocardiographic examination because of palpitations. He had a history of an atrial septal defect surgically treated with an artificial synthetic polyester textile fiber patch. TTE showed a large, mobile mass in a dilated left atrium. The attachment site of the mass was not clear by transthoracic approach, and it was difficult to diagnose the mass as a thrombus or a myxoma from the nature of the echocardiographic findings. Transesophageal echocardiography clearly demonstrated that the mass was attached to the patch closing the atrial septal defect and the mass was confirmed as thrombus at surgery. A patient with left atrial thrombus in whom transesophageal echocardiographic demonstration of the attachment of the left atrial mass to a patch closing an atrial septal defect served as an essential clue leading to accurate diagnosis is reported. Transesophageal echocardiography is feasible to evaluate the attachment site of a left atrial mass and to lead to an accurate diagnosis.     

Endocarditis caused by Lactococcus lactis subsp. lactis in a patient with atrial myxoma: a case report

We report a case of subacute endocarditis in a 55-year-old patient affected by left atrial myxoma and with a severe mitral regurgitation. Lactococcus lactis subsp. lactis was isolated from blood cultures and infection was eliminated by treatment with amoxicillin-clavulanic acid.     

Left atrial mobile hydatid cyst mimicking left atrial myxoma and mitral stenosis and causing heart failure and arrhythmia

Cardiac hydatid cysts are very rare in hydatid cyst disease. We report herein a case of hydatid cyst mimicking left atrial myxoma. A 78-year-old woman was admitted to our hospital with complaint of dyspnea and signs pulmonary edema and mitral stenosis. Echocardiography showed left atrial mobile, mostly solid mass with wall calcifications moving towards the orifice of the mitral valve. We also found loculated giant hepatic and right pulmonary cysts. We aimed to report this case because of mimicking mitral stenosis and left atrial myxoma and causing heart failure.     

Recurrence of nonfamilial cardiac myxoma in the left ventricle: A case report

A left atrial myxoma was found and removed in a 47‐year‐old woman admitted for acute ischemic cerebrovascular disease, without family history of cardiac tumor. Follow‐up echocardiography, 15 months later, demonstrated a new myxoma in the left ventricle. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :576–577, 2014     

Left atrial mass caused by metastatic renal cell carcinoma: an unusual site of tumor involvement mimicking myxoma.

We report a case of a left atrial mass echocardiographically mimicking myxoma, in a patient with renal cell carcinoma. The mass was pathologically confirmed to be metastatic carcinoma, which had entered the left atrium from a mediastinal lymph node, via direct invasion of a pulmonary vein, illustrating the potential for unusual routes of tumor spread into the heart and the importance of obtaining a tissue diagnosis in such cases.     

心脏黏液瘤的临床及超声特点探讨

目的探讨心脏黏液瘤的临床及超声特点。方法选取11例心脏黏液瘤患者,男5例、女6例,行多普勒超声检查,均经手术和病理证实,分析患者的临床特点及超声特点。结果 11例患者的临床表现包括胸闷、心悸、发热、晕厥、脑梗死、心律失常等,体征包括舒张期杂音、双期杂音、肿瘤扑落音等。11例患者均为单发,左房多见,超声表现为心房内稍高回声团块,边界清晰,部分呈分叶状,大部分内部回声较均匀,多数瘤体有蒂附着于房间隔上,随心动周期规律摆动,同时并发心房增大,下腔静脉增宽等。结论心脏黏液瘤临床表现个体差异极大,但超声表现较为典型,可以作为该病的首选检查方式。     

Echocardiographically evaluated site of attachment of atrial myxoma may predict recurrence

We explore the association between the site of attachment of nonfamilial left atrial myxoma and it’s recurrence. Forty-three (11 male and 32 female; mean age, 55.9±13.6 years) of 49 consecutive patients with nonfamilial left atrial myxoma who had been evaluated with preoperative echocardiography, X were available for postoperative follow-up with transthoracic echocardiography, transesophageal echocardiography, or both, for an average period of 85.2±54.2 months (range, 6.5 to 215.5 months). We compared preoperative clinical and echocardiographic features of recurrent and nonrecurrent myxomas. Three (7%) of the 43 cases of atrial myxoma recurred at the same site after 24.1±7.6 months. Involvement of the mitral valve annulus or mitral valve leaflet (3 vs 0,p<0.001) was observed in the recurrent myxomas, but the two groups did not differ significantly in any other clinical features, laboratory data, or echocardiographic features of the recurrent and nonrecurrent myxoma. Preoperative echocardiographic observation of involvement of the mitral valve annulus or mitral valve leaflet may predict recurrence after surgery. Regular follow-up echocardiography was useful in the early detection of recurrence.     

Multiple cerebral and coronary aneurysms in a patient with left atrial myxoma

Cardiac myxomas accompanied by multiple embolic complications in cerebral and visceral arteries have been well documented in scientific literature. However, cerebral artery aneurysms have rarely been reported as a possible embolic complication of myxomas. This study describes a patient who had multiple episodes of cerebral infarctions and was found to have left atrial myxoma with old renal infarction as well as cerebral and coronary artery aneurysms. This is the first case report of coronary artery aneurysms associated with cardiac myxoma.     

Echocardiographic diagnosis of a left atrial myxoma found attached to the free left atrial wall

The echocardiographic diagnosis of a left atrial myxoma is described. This was later confirmed by cardiac catheterization and the tumor removed at operation. The myxoma was found to arise from the free left atrial wall and no such case diagnosed by echocardiography has previously been reported. The possibility of false negative and false positive echocardiographic findings is discussed. Echocardiography is an accurate, atraumatic, and rapid diagnostic technique which can be used as a simple screening procedure in cardiac evaluations.     

慢性心房颤动患者心房组织中IL-6的变化及临床意义

目的 探讨IL-6在慢性心房颤动（AF）患者中的作用,为指导临床防治AF奠定理论基础.方法 依据〈赫尔辛基宣言〉精神选择20例行心脏外科手术患者,其中AF组10例,男5例,女5例,年龄39-64（52.1±10.05）岁,心功能Ⅱ级3例,Ⅲ级7例,其中左房粘液瘤2例,冠状动脉粥样硬化性心脏病4例,风湿性心脏瓣膜病4例,入选患者无其他心律失常病史且AF持续时间在6个月以上.窦性心率组（SR）10例,男4例,女6例,年龄21-69（41.2±18.75）岁,心功能Ⅱ级4例,Ⅲ级6例,其中左房粘液瘤3例,冠状动脉粥样硬化性心脏病4例,风湿性心脏瓣膜病3例,入选患者无心律失常病史.所有患者在心脏停跳前获取右心耳组织100 mg,去除血液及脂肪组织,转入-70℃冰箱冻存、备用.用ELISA法测定右心耳组织中IL-6的水平.结果 AF组心房组织中IL-6的水平明显高于SR组心房组织中的IL-6水平,统计学有显著差异（P＜0.05）.AF患者心房组织中IL-6的水平与LAD呈正相关,统计学有显著性差别（r=0.94,P＜0.05）.结论 IL-6参与了AF的病理过程.     

An unusual cause of sudden death: Cardiac myxoma

Primary tumors of the heart are rare; the most common cardiac tumor is atrial myxoma. Sudden death may occur in patients with atrial myxoma, tumor embolization, or obstruction of blood flow at the mitral or tricuspid valve. This report describes an unusual cause of sudden death and the autopsy findings for a 73-year-old man with left atrial myxoma.     

心房黏液瘤合并动脉栓塞的CT表现与临床治疗

目的 探讨心房黏液瘤合并动脉栓塞的CT表现、临床治疗及疗效。方法 收集6例左心房黏液瘤合并动脉栓塞患者,均于完善包括冠状动脉及外周动脉CTA检查在内的相关检查后行手术治疗;对其CTA表现及临床资料进行回顾性分析。结果 6例心房黏液瘤均发生于左心房,CT平扫呈低密度,3例动脉期强化,蒂宽窄不等,1例伴有钙化;6例均伴有动脉栓塞,栓塞部位为髂动脉2例、 肱动脉1例、 股动脉2例和腹主动脉伴两侧髂动脉多发栓塞1例。采用同期或分次心房黏液瘤切除联合外周动脉Fogarty导管取栓术进行治疗,无死亡病例,术后患者肢体疼痛消失。随访6个月~2年,均无心房黏液瘤复发或取栓部位黏液瘤再发种植转移,受累肢体血运良好。结论 CTA可对心房黏液瘤合并动脉栓塞作出较全面的诊断;采用心房黏液瘤切除辅以栓塞动脉Fogarty导管取栓术进行联合治疗可获得满意疗效。     

Cardiac Myxoma: A Rare Case Series of 3 Patients and a Literature Review

Myxoma is the most common tumor in the heart. A typical myxoma is relatively straightforward to diagnose. However, certain cardiac myxomas have rare features. We report three extremely rare cases of cardiac myxoma. One case involved a myxoma that originated from the annulus of the tricuspid after valvuloplasty, one case involved myxomas associated with left atrial thrombus and severe mitral stenosis, and the third case involved myxoma combined with severe calcification. All three cases were diagnosed by echocardiography and pathology. We also review clinical presentations and diagnostic characteristics of cardiac myxomas.     

A new intracavitary lesion at echocardiography and MR: a case of mistaken identity

Atrial myxomas often show contrast enhancement following administration of intravenous gadolinium, whereas thrombus appears as a hypointense structure, typically without any contrast enhancement. This case report presents a diagnostic challenge involving a recently developed left atrial mass in which echocardiography and cardiac MRI provided discordant results. While the morphological characteristics of the new left atrial lesion were suggestive of myxoma, the signal characteristics and behavior following intravenous gadolinium at MR, and, in particular, the rapid interval appearance of the lesion, prompted consideration for left atrial thrombus. Subsequent intra-operative and histopathologic evaluation proved the mass to be a left atrial myxoma.