Giant left atrial myxoma mimicking severe mitral valve stenosis

We report a case of giant left atrial myxoma in a young patient with clinical manifestation as congestive heart failure attributable to severe mitral valve stenosis. An early clinical and echocardiographic diagnosis was performed and the patient had an optimal outcome with surgery treatment.     

Infected left atrial myxoma

Myxoma is the most common primary tumor of the heart. It is uncommon for these tumors to become infected and, at times, clinical presentation is no different from that of an uninfected myxoma. We describe the case of a 58-year-old woman with a previous pharyngeal infection that developed into infection of a left atrial myxoma and which was complicated by systemic embolism affecting the lower limbs. Streptococcus oralis was identified in blood cultures and embolic material. The tumor was resected and the patient's subsequent clinical evolution was uneventful. The incidence of infected myxoma is very low. A review of the literature based on individual case reports is presented.     

Infected left atrial myxoma

A 47-year-old Japanese woman with a continuing high fever was promptly diagnosed as having infected atrial myxoma one day after admission based on transthoracic echocardiographic findings and positivity for bacteria in blood culture. The mass was removed by an urgent open heart surgery. Histopathological examination confirmed that this mass was a myxoma with gram-positive bacterial colonies. Generally, antemortem diagnosis is difficult and there is a high mortality of patients with infected myxoma; however, this patient completely recovered from the illness because of the prompt diagnosis. This is the 37th case of definite infected myxoma reported in the literature. The cause of infection of this patient might have been the acupuncture therapy she underwent for weight reduction.     

Neovascularization in left atrial myxoma

Myxoma is the most common benign tumor of the heart. Tumor neovascularization at the angiographically detectable level is thought to be rare. We report on a 78-year-old female patient with a left atrial myxoma showing marked tumor vascularity. This observation had consequences to the therapeutic management: during tumor excision, the large supplying artery had to be ligated.     

The echocardiogram in left atrial myxoma

A case of left atrial myxoma is described in which the echocardiogram provided the clue to the diagnosis. The mechanisms involved in producing a positive result are discussed. The value of the echocardiogram appears to depend upon echoes from the tumor during diastole which can be detected immediately posterior to the anterior cusp of the mitral valve. In this case the tumor was successfully removed with restoration of the normal pattern of mitral valve movement.     

Strongly neovascularized left atrial myxoma

During transesophageal echocardiography, a massively vascularizedleft atrial tumor was found in an 82-year-old woman with transientischemic attacks. Coronary angiography showed several feedingvessels from the left circumflex artery and right coronary artery,which resulted in marked contrast enhancement of the left atrialtumor. Histological examination after tumor excision confirmedthe suspicion of neovascularized myxoma.     

Postoperative atrial fibrillation in patients with left atrial myxoma

Paroxysmal atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery such as coronary artery bypass grafting (CABG), and often occurs between the second and fourth postoperative days.1,2 The reported incidence of paroxysmal AF after CABG surgery varies widely, from five to 40%, which is lower than in cases of valvular cardiac surgery.3,4 Although this arrhythmia is usually benign and self-limiting, it may also be associated with increased risk of embolic events, haemodynamic instability, haemorrhagic complications, prolonged hospital stay and higher rates of re-admissions, increasing the healthcare costs.5-7Several risk factors have been proposed for paroxysmal AF after CABG or valvular cardiac surgery, such as advanced age, genetic predisposition, chronic obstructive pulmonary disease, heart failure or increased peri-operative ischaemia.8-10 In addition, certain echocardiographic parameters such as left atrial (LA) diameter or left ventricular (LV) function, and electrocardiographic parameters including P-wave duration and P-wave dispersion (Pd) have been shown to be associated with postoperative AF.11-13Although postoperative AF and its predictors after CABG and valvular surgery have been well researched, no study has been performed to explore the incidence or predictors of postoperative AF in patients with LA myxoma. The aim of this study was to identify the prevalence and predictors of postoperative AF in a pure cohort of patients with LA myxoma.     

Retinal embolism from left atrial myxoma

Retinal artery embolism that had arisen as a complication of a left atrial myxoma was diagnosed in a young man who had suddenly developed a visual disorder in his left eye. A tumor in the left atrium was surgically excised. Pathologically, retinal embolism secondary to atrial myxoma is rare. To our knowledge, only 15 cases have been documented so far. The present case was only the second case of an isolated retinal embolism that had developed without systemic involvement, and the first case of retinal artery branch embolism that had resulted from a left atrial myxoma.     

Echocardiographic diagnosis of left atrial myxoma

The presence of a left atrial myxoma in a young woman who presented with mitral valve obstruction was established by echocardiography before surgery. A systematic echocardiographic approach to such a patient is described, by which other diagnostic possibilities, including artifacts, may be eliminated. It is indicated that echocardiography should be performed in patients with suspected obstructive lesions at the mitral valve, unexplained syncope or suspected bacterial endocarditis, as well as in patients who have had atrial myxomas removed since these tumors occasionally recur.     

Recurrence of a left atrial myxoma

A fatal recurrence of a left atrial myxoma was observed despite resection of the original tumor complete with its stalk and a portion of atrial septum. The evidence suggests that this recurrent tumor developed from “pre-tumor” cells in the region of the fossa ovalis. The rate of growth of the second tumor was faster than would have been predicted. Clinical manifestations were similar to those with the initial tumor. Wide excision of the atrial septum with the stalk of such tumors should offer the best chance for operative cure, but prolonged postoperative observation is important if signs of recurrence are to be detected at a time when operative removal can be carried out with minimal risk to the patient.