Transesophageal echocardiographic diagnosis of multicentric left ventricular myxomas mimicking a left atrial tumor.

We report a case of multicentric left ventricular myxomas with prolapse of one myxoma into the left atrium during ventricular systole that mimicked a left atrial tumor. The transthoracic echocardiogram showed large masses in the region of the mitral valve leaflets consistent with vegetations or tumors. A computed tomographic scan of the chest demonstrated two distinct left atrial masses, one of which appeared to prolapse from the left atrium into the left ventricle. Intraoperative transesophageal echocardiography showed a large pedunculated mass moving between the two left-sided cardiac chambers with intermittent trapping of the mass in the left atrium. The mass was attached to the left ventricular posteromedial papillary muscle by a long stalk. Another adjacent large ventricular mass was also noted in the left ventricle. These findings were confirmed at operation, which also demonstrated a third small tumor arising from the atrial aspect of the posterior mitral leaflet.     

Undifferentiated pleomorphic sarcoma in the left atrium; report of a case

Primary cardiac sarcomas are rare. A 41-year-old woman complaining of dyspnea was admitted to our hospital. Echocardiography and computed tomography (CT) showed a primary cardiac tumor in the left atrium. During surgery, the tumor was noted to be arising from the anterior wall of the left atrium, under the aortic sinuses. Histological and immunohistochemical studies revealed an undifferentiated pleomorphic sarcoma. Eleven months later, echocardiography and CT showed recurrence of the cardiac sarcoma in the left atrium. The patient underwent wide resection of the left atrium and mitral valve replacement because the tumor extended to the mitral valve leaflet. The patient died 3 months after the 2nd surgery because of the 2nd recurrence of the cardiac sarcoma. Although most tumors that develop in the left atrium are benign myxomas, preoperative differential diagnosis is important. It is especially necessary to suspect a sarcoma in the case of a non-septal orgin of the mass.     

Three cases of left atrial myxoma

Three cases of left atrial myxoma are presented. All of them were diagnosed by echocardiography, computed tomography and cardiovascular angiography. At operation, origin of the tumors were found to arise from the vicinity of the fossa ovalis in two cases and the lower atrial septum in the other. Three different operative maneuvers were used in these three cases. In the first case, the left atrium was incised and the tumor was removed submucosally. In the second case, the left and right atrium were incised and the tumor was removed with atrial septum. In the third case, only the right atrium was incised and the tumor was removed with atrial septum. In comparison of these three different maneuvers, we conclude that the second case was most appreciable, because the operator could see whole sight of the left atrial cavity and whole contour of the tumor and remove the tumor completely without destruction. All these patients have done well for periods of follow-up ranging from 10 to 37 months.     

Liposarcomatous tumor emboli to the left iliac artery growing intraluminally into the femoral artery. A report of an operative and autopsy case

A 74-year-old female patient with a past history of the locally recurrent tumor of the liposarcoma in the right thigh over 20 years ago received an emergency vascular operation to relieve severe ischemic symptoms in the left leg. The left femoral artery was pulseless and was filled with several long, translucent and cord-like tumors which resembled the hands of a cuttlefish. The tumors were easily removed except its root adhering to the left common iliac artery. A crossover femoro-femoral artery bypass was carried out. On the 24th postoperative day she died suddenly. The autopsy findings were as follows: A hen egg-sized tumor occupied almost whole space of the left atrium, and connected with the metastatic right lung tumor via the pulmonary vein. The sudden death was probably due to the abrupt obstruction of the mitral valve by the tumor in the left atrium. The residual tumor was noted in the left common iliac artery, but its adventitia was not involved. The pathohistological diagnosis of each tumor was same, well differentiated liposarcoma. The tumors which occluded the left iliofemoral artery must have originated from the tumor in the left atrium in form of the tumor embolism, lodged in the left common iliac artery, grown intraluminally into external iliac and femoral artery, and finally caused ischemia of the left leg.     

Multiple left ventricular myxomas arising from the interventricular septum and ventricular trabeculae: a case report

Myxoma is the most common tumor of the heart, with an estimated incidence of 0.5 to 1 per million per year. The majority of these tumors arise from the left atrium, and 20% arise from the right atrium with the remaining 5% arising in either the right or left ventricle. We present a rare case of multiple myxomas of the left ventricle arising from the interventricular septum and nearby ventricular trabeculae that clinically presented with an occlusion of the left axillary artery. The patient was successfully treated using cardiopulmonary bypass, during which the tumor was completely removed using a transventricular approach.     

Right ventricular and left atrial and left ventricular myxomas: report of a case

Myxomas are common cardiac tumors, which are usually managed by complete excision. We report a case of myxomas at different stages of development found simultaneously in the left atrium and both ventricles. The patient underwent successful surgical excision of all myxomas and there has been no clinical or echocardiographic evidence of recurrence or valvular insufficiency in 6 months of follow-up.     

Surgical excision of malignant pheochromocytoma in the left atrium.

We present a rare case of malignant pheochromocytoma in the left atrium and its surgical treatment. The patient was a 39-year-old male who presented a low-grade fever with perspiration. A large tumor was first detected in the left atrium by chest CT, and was confirmed by ultrasonic echo cardiogram and chest MRI. A left adrenal tumor was indicated also by abdominal echography. To prevent the risk of its embolization, surgical excision was performed on a subemergency basis. The patient developed near Shock State on the operative day, presumably due to catecholamine depletion. The preoperative urinary levels of norepinephrine and dopamine were abnormally high. Bilateral adrenal tumors also, confirmed postoperatively by abdominal MRI, were developing rapidly. The pathological examination revealed that the tumor was a pheochromocytoma.     

The new assessment of left atrial plication for giant left atrium

AIM: Left atrial plication is occasionally performed to reduce the size of the left atrium. We present our new method of evaluating the effect of plication on giant left atrium. METHODS: Respiratory and cardiac function were evaluated before and after left atrial plication in 8 patients with giant left atrium. At the same time, the postoperative changes in the ratio of left atrial volume to left ventricular end-diastolic volume and left atrial volume to stroke volume were examined. These values were also compared with those of 5 patients who underwent individual mitral surgery and of 9 patients with normal cardiac function. RESULTS: No significant change was seen in vital capacity, percent of one second forced expiratory volume, ejection fraction, pulmonary capillary wedge pressure and left ventricular end-diastolic volume index, while left atrial dimension and left atrial volume decreased significantly. Both the ratio of left atrial volume to left ventricular end-diastolic volume and the ratio of left atrial volume to stroke volume decreased after surgery; the significant difference disappeared compared to the normal values. CONCLUSION: Left atrial plication is a useful method for patients with giant left atrium, since it corrects the disproportion between atrial and the ventricular volumes, which may decrease the left ventricular preload and increase the flow velocity passing through the mitral valve. The ratio of left atrial volume to left ventricular end-diastolic volume and to stroke volume are helpful for evaluating the efficacy of plication.     

Double-outlet left atrium with intact ventricular septum

The clinical course and surgical repair of double-outlet left atrium with intact ventricular septum in a 13-year-old girl are presented. The only outlet of the right atrium was a secundum atrial septal defect, and the left atrium drained into both ventricles through two atrioventricular valves. To our knowledge, there has been only one other published report of repair of double-outlet left atrium.     

First experience of cardiac autotransplantation for giant left atrium treatment

Giant left atrium is a pathology that causes a lot of different complications, therefore it is very important to perform volume reduction. In some cases left atrium volume reaches a huge size. There are a lot of different methods for left atrium reduction: from wall plication, multicomponent resection followed by restoration integrity of wall to autotransplantation. In spite of the relative simplicity of plications and resection, these methods do not always allow to reduce left atrium to the desired volume. Cardiac autotransplantation is the most radical approach to the correction of giant left atrium which allows reducing left atrium including interatrial septum. The successful result of giant left atrium surgical treatment (volume of left atrium is 2200 ml according to the data of computerized tomography) by the method of autotransplantation is presented in the article.     

Repair of left superior vena cava entering the left atrium

Connection of an anomalous left superior vena cava to the left atrium is an uncommon lesion that is usually associated with other complex intracardiac malformations. A technique for diverting the anomalous caval return along the left atrial roof and into the right atrium is presented. This simple tunnel method avoids potential obstruction to systemic and pulmonary venous return and leaves viable atrial tissue comprising the majority of the new pathway. The technique and results in 7 patients are described.     

Growth of a left atrial sarcoma followed by resection and autotransplantation

Left atrial sarcomas are among the rarest primary cardiac tumors. This type of tumor has an aggressive behavior and is often resistant to standard approaches to treatment. In this case report we show its rapid growth in vivo and document successful local control with an aggressive surgical approach of ex-vivo resection, reconstruction of the left atrium by a pericardial patch, and subsequent autotransplantation.     

Advanced lung cancer invading the left atrium wall treated with pneumonectomy and combined resection of the left atrium using stapling devices: report of two cases.

In chest surgery, stapling devices are primarily used to close bronchi. However, they are also used for dissection and suturing between lung lobes, resection and plication of lung tissue (including bullae), combined resection of the superior vena cava, closure of the pulmonary great vessels, closure of the left atrium following combined resection of the left atrium, and so on. We recently treated two cases of advanced lung cancer, which had invaded the left atrial wall, with pneumonectomy and combined resection of the left atrium using stapling devices, and obtained favorable results. For combined resection of the left atrium, it is safer to use stapling devices than vascular clamps, since the latter involve the risk of dislocation during use. Furthermore, since stapling devices require no margin for suturing, the left atrium can be resected at a point sufficiently distant from the cancer, thus allowing for highly radical resection. Stapling devices are also useful because they can be manipulated even within narrow operative fields. When dealing with lung cancer requiring combined resection of the left atrium, pneumonectomy is needed in most cases. When performing surgery for these cases, it is essential to first close and divide the bronchi and pulmonary arteries and veins as far as possible so that adequate adherence around the left atrium can be developed and the entire lung can be lifted up, followed by resection of the left atrium with a stapling device applied to the left atrium without any tension.     

Surgery of left atrial myxomas. Report of eleven cases and review of the literature

Eleven patients with left atrial myxoma in a ten-year period were reviewed. They ranged from 16 to 69 years old. Eight patients were female. All tumors were located in the left atrium; one patient had multiple tumors. The main clinical presentation was congestive heart failure seen in eight patients. Ten patients had a correct pre-operative diagnosis. Echocardiography confirmed the diagnosis in seven patients, angiocardiography in two and cardiac catheterization in one. All tumors were successfully removed with the aid of cardiopulmonary bypass and using a right atriotomy and trans-septal approach. Two patients underwent concomitant saphenous vein aortocoronary bypass. There were no operative deaths. Excision of the tumor resulted in marked symptomatic improvement. There have been no recurrences. A review of the pertinent literature is presented.     

Surgical repair of common atrium associated with persistent left superior vena cava draining into the left atrium

A case of 54-year-old female of common atrium associated with persistent left superior vena cava (PLSVC) draining into the left atrium and absence of the coronary sinus was experienced. The corrective surgery was done by using a horseshoe-shaped autologous pericardial patch to make a new atrial septum to allow the PLSVC draining into the right atrium. Since the common atrium is frequently associated with maldrainage of the PLSVC, the surgical treatment should be determined according to existence of the PLSVC and its opening site.     

Persistent left superior vena cava causing subdivided left atrium: diagnosis, embryological implications, and surgical management

A 3-month-old infant is described in whom a persistent left superior vena cava impinged on the posterior wall of the left atrium, producing a subdivided left atrium with left-to-right shunting and congestive heart failure. To our knowledge, this anomaly has not previously been reported. The preoperative diagnosis, surgical management, and embryological implications are discussed.     

Descriptive analysis of instantaneous left atrial volume—with special reference to left atrial function

Instantaneous left atrial volume was determined in five calves by electrical integration of left atrial differential flow (pulmonary vein flow less mitral valve flow). Volume changes were classified and compared to previously described mitral valve flow phases. With the onset of left ventricular isovolumic contraction, the left atrium began to fill. There was an initial rapid filling period, followed by a slower but steady increase in volume. With reversal of the atrioventricular gradient, there was an initial decrease in left atrial volume. This decrease then reached a plateau, during which the left atrium remained isovolumic. With atrial contraction there was a further decrease in left atrial volume. Left atrial function (reservoir, pump, or conduit) was evaluated using an algorithm to emphasize major changes. Reservoir function occurred mainly during ventricular systole, but was also seen during diastole. Pump function occurred only during ventricular diastole and could be further divided into passive and active components. The passive component contributed the majority of blood transfer from the atrium into the ventricle. Active atrial contraction provided only 13% of the stroke volume but under the conditions of normal sinus rhythms occurred at the most sensitive point of ventricular filling. Conduit function was seen during ventricular diastole, was inversely related to the reservoir and pump functions, and thus produced a rate of ventricular filling smoother than expected and permitted a maximal transfer of blood from the left atrium into the ventricle.     

Free-floating left atrial ball thrombus without mitral valve disease

Reports of left atrial ball thrombus without mitral valve disease are few. We experienced a case of free-floating left atrial ball thrombus that developed in a short period in a patient with atrial fibrillation and dilated left atrium but intact mitral valve. Surgical removal of the thrombus was performed. It was presumed that atrial fibrillation and enlarged left atrium were the contributory factors to thrombus development.     

Effective reduction of a giant left atrium by partial autotransplantation.

Although many surgical procedures have been proposed to reduce the size of a left atrium, their effectiveness is not well established. We present a case of mitral and tricuspid valve insufficiency with a giant left atrium. Partial heart autotransplantation was used in a mitral and tricuspid valve operation with a successful outcome. This procedure can be an effective method to treat giant left atrium.     

Echo-guided extirpation of huge left atrial myxoma

A 41-year-old male undergoing outpatient therapy for hypertension was to have a mass in the left atrium by echocardiography for screening. Transesophageal echocardiography did not identify the attachment of the tumor. The optimal approach to the tumor was determined depending on the findings of intraoperative echocardiography which well visualized the attachment of the tumor. The tumor, a large myxoma filling the most inner space of the left atrium, was extirpated via incisions in the right atrium and interatrial septum. Intraoperative echocardiography is an extremely useful method to determine the optimal approach for tumor resection. It is especially useful in cases of left atrial myxoma which has an unclear attachment on preoperative examination.