Rapidly growing papillary fibroelastoma complicated by myxoma

Rapidly growing papillary fibroelastoma complicated by myxoma is extremely rare. An 80-year-old male was transported to our hospital because of cerebral hemorrhage. Echocardiogram revealed a massive pedunculated tumor in the septum of the left atrium. The tumor extended to the mitral valve orifice and posed a risk of strangulation, yet removing it immediately would have required cardiopulmonary bypass with anticoagulant, which would have posed a serious risk of rebleeding. Magnetic resonance imaging showed that the tumor stalk was sufficiently thick for us to perform a standby surgery 1 month after cerebral hemorrhage. Follow-up echocardiogram prior to this surgery revealed a new, high-mobility tumor in the right ventricular septum. We resected these two tumors together. Histopathological examination showed that the tumor of the left atrium was a myxoma and the tumor of the right ventricle was a papillary fibroelastoma. The patient had a good postoperative course and was discharged without complications.     

Pulmonary artery obstruction in a pediatric patient during removal of a right ventricular myxoma

Cardiac myxoma, especially right ventricular myxoma is very rare. We report a 2-year-old girl who underwent the emergent surgical resection of a right ventricular myxoma. She was noticed to have systolic murmur and was referred to our hospital. Echocardiography and magnetic resonance imaging (MRI) revealed the presence of tumor extending from the right ventricle across the pulmonic valve into the pulmonary artery. Anesthesia for the removal of a right ventricular myxoma should be carried out carefully, because pulmonary tract obstruction may occur during the procedure. During the removal of the tumor, the tumor obstructed the pulmonary artery resulting in severe decrease of the blood pressure and the heart rate. Because pulmonary artery occulusion occurred after pericardiotomy, chest massage was started quickly and in 15 minutes cardiopulmonary bypass was established. The tumor was removed completely and was diagnosed as myxoma by histological examination. The patient recovered uneventfully and was discharged without complications.     

Right atrial giant myxoma occupying the right ventricular cavity

We report a case of a giant right atrial myxoma mimicking the right ventricular tumor. The 75-year-old patient underwent cardiac surgery, and the tumor was excised along with the stalk. Tricuspid valve annuloplasty was performed before closure of the right atriotomy. The tumor may have caused intraventricular stenosis, hepatic dysfunction, and progressive fatigue as a result of low cardiac output. This case is of special interest because the myxoma was very large compared with those ever reported, and a right atrial myxoma occupying the right ventricular cavity is rare.     

Technique of excision of LV myxoma prolapsing into aorta

A life-threatening Left Ventricular (LV) outflow tract obstruction developed in a 29-year-old lady because of a very uncommon myxoma emerging from the left ventricular apex. Immediate surgical treatment was indicated because of high-risk factors reported herein. After transaortic resection of a single myxoma, the progress of this patient has been excellent We describe a technique of excision of a left ventricular myxoma prolapsing into the aorta. We successfully excised a 5.4 × 3.2 cm tumor prolapsing into the aorta via the transaortic approach under Femoro-bicaval bypass.     

Multiple myxoma in the left ventricle and the left atrium

Left ventricular myxoma is particulary rare. Our case is a 77-year-old female. Transesophageal echocardiography showed a giant tumor in the left atrium. An urgent operation was performed. A giant mass was excised en bloc via a transinteratrial septal approach. Histopathologically it was myxoma. As a transthoracic echocardiography at 1-year postoperation showed a tumor in the left ventricle. A mass was excised en bloc via a vertical approach. Histopathologically it was diagnosed again as myxoma. We looked at the earliest transesophageal echocardiogram again, and found the small tumor on the same area under the posterior mitral leaflet. At the diagnose of cardiac tumor, possibility of multiple formation should be always considered.     

A case of right atrial myxoma, originating from the eustachian valve

We describe a rate of right atrial myxoma, originating from the Eustachian valve, which entered and occupied the right ventricle during the diastolic phase. A 65-year-old woman was admitted with symptoms of palpitation and tachycardiac attack. The condition was diagnosed by echocardiogram and an emergency operation performed. The tumor was removed with the endocardium around 1 cm2 at its stalk in order to prevent recurrence of tumor. No recurrence has developed during the subsequent 2 years 4 months.     

Familial atrial myxoma in three generations: case report

Familial myxomas constitute 7 % of the total myxoma population exhibiting Mendelian autosomal dominant inheritance. We present a rare case of autosomal dominant benign familial myxoma occurring in three generations of the family operated successfully at our institute. A 40-year-old female presented with chest pain and palpitation, was diagnosed with left atrial myxoma, and was operated in 1993. After 2 years of surgery, the patient developed recurrent myxoma, and excision was done in 1995. A 22-year-old son complained of dyspnoea and chest pain. On evaluation, 5.6?×?2.6 cm right atrial myxoma attached to the roof of the right atrium was found, and the patient underwent myxoma excision in 2007. A 3-year-old granddaughter suffered from right hemiplegia. Echocardiography revealed left atrial myxoma 3 cm?×?2 cm pedunculated lesion causing diastolic obstruction of mitral inflow. Operated patients in all three generations and other siblings have been genetically screened. On genetic evaluation, all diseased had autosomal dominant single-gene defect or microdeletion. Atrial myxomas presented at earlier age successively and in more aggressive form in these three generations.     

Diagnosis and treatment of 52 cases of cardiac myxoma

43 patients with cardiac myxoma had undergone surgical removal of the tumors under CPB 38 tumors were located in the left atrium, 5 in right atrium, and 1 in right ventricle respectively. The sites of attachment of the tumor stalk observed during operation were as follows: 34 left atrial myxomas were attached to the interatrial septum and 4 left atrial myxomas to the atrial wall. 5 right atrial myxomas were attached to the interatrial septum and 1 right ventricular myxoma to the ventricular wall. 1 patient with a right ventricular myxoma which had been removed one year ago appeared new one in the left atrium and the tumor was cut too. The diagnosis of cardiac myxoma was confirmed by 2D-echo-cardiography in all of our cases. Mitral valve replacement was done in 1 patient in this series. There was one death postoperatively. Besides these 43 cases, there were 9 patients who had not been operated upon, because of refusal of operation in 5, sudden death from cardiac arrest before operation in 2, coma from cerebral thrombosis in 1, and serious pulmonary tuberculosis in another one respectively.     

Successful excision of right ventricular myxoma

A 17-year-old woman with right ventricular myxoma is reported. The diagnosis was made by means of two-dimensional echocardiography. Under extracorporeal circulation, the tumor was successfully excised through a right atrial approach. Right ventricular myxoma is a rare disease but when the exact diagnosis has been established, urgent operation is mandatory because of the impending danger of sudden death from pulmonary embolism or obstruction of the outflow tract by the tumor.     

A successful resection of recurrent right ventricular myxoma]

A successful surgical treatment of right ventricular myxoma of twenty-year-old male was presented, who healed already previous resection of left atrial myxoma two year and eight months prior to this operation. He has been followed up closely after the first resection of left atrial myxoma for the recurrence in the left atrium. Follow-up echocardiography demonstrated the development of myxoma in the free wall in the right ventricle. The resection for this myxoma was found to be relatively easy at the second operation. The tumor was removed with the stark, without any postoperative problem. According to the literature, this case seems to be the second Japanese case of surgical treatment of right ventricular myxoma following the removal of left atrial myxoma.     

Giant left atrial myxoma causing severe pulmonary hypertension

This report describes a case of giant left atrial myxoma in a 43-year-old woman. She presented with general malaise and dyspnea. Electrocardiogram showed severe right-axis deviation. Transthoracic echocardiography demonstrated a giant mobile mass with size of 6.5 × 4.5 cm in the left atrium. This mass protruded into the left ventricle in diastole and disturbed transmitral left ventricular filling flow. Bilateral atrium and right ventricle were dilated. Severe tricuspid regurgitation was demonstrated with peak pressure gradient of 91 mmHg. This mass was surgically excised and was diagnosed as benign atrial myxoma by histological analysis. Pulmonary hypertension was improved after surgery.     

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.     

A case of cardiac myxoma with multiple brain hemorrhage]

A case of cardiac myxoma with multiple brain hemorrhage is reported. A 57-year-old male had complained of lower abdominal pain, diarrhea and fever for 3 days. On admission, he was in a condition of disseminated intravascular coagulation and sepsis. An abdominal CT scan showed infarction in the right kidney and spleen and an echocardiogram also showed myxoma in the left atrium. Although he presented no neurological symptoms, the brain CT showed multiple brain hemorrhage in the bilateral brain hemispheres. Total resection of the tumor was carried out for the improvement of the patient's general condition. Vimentin, S-100 protein and neuron specific enolase was positive in immunological staining and the pathological diagnosis was myxoma. Postoperative recovery of consciousness was poor and left hemiparesis developed. CT showed the increase of hematoma but angiography showed no cerebral aneurysm. The symptoms improved with conservative therapy. However the enhanced lesion remained in the right parietal lobe and an operation was performed 5 months later. The myxoma cell could not be found in the pathological examination, so tumor embolism, cerebral infarction, hemorrhagic infarction due to DIC, hematoma enlargement caused by heparinization during operation were suspected to have occurred in this order without tumor growth.     

Intraoperative video-assisted resection of left atrial myxoma through the right parasternal approach]

A 58-year-old man admitted with atypical chest pain, and an echocardiogram showed a tumor in the left atrium. The tumor widely originated from the interatrial septum and the superior-anterior inner surface of the left atrium did not disturb a mitral valve motion. A right coronary angiogram demonstrated feeding arteries of the tumor. The right parasternal skin incision was made and the tumor was completely removed through the interatrial incision under the video-assisted fiberscopic system. Nd-YAG laser was exposed on the tumor-resected surface for laser coagulation resulting in tumor necrosis. Pathological examination revealed myxoma with rich neovascularization. On the 12th day the patient discharged without complications.     

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.     

Current Management of Atrial Myxoma with Emphasis on a New Diagnostic Technique

Sixteen patients aged 22-64 years have undergone removal of atrial myxoma at the Johns Hopkins Hospital. The first two patients had myxomas removed by closed surgical approach, and both died. Fourteen consecutive patients have undergone operation with the aid of cardiopulmonary bypass, and all survived. There has been one late death unrelated to myxoma. Current surgical approach is excision of the tumor and its stalk or base and resection of the portion of intra-atrial septum to ensure complete removal. Recently a new diagnostic technique of two-dimensional phased array real time echocardiography has been used in four patients, including a pregnant woman, to confirm the clinical diagnosis of atrial myxoma. This technique provides a two-dimensional view of both atria and ventricles in cross section or sagittal view. This noninvasive method is painless, is independent of cardiac function and carries no risk or radiation hazard. The two-dimensional echocardiogram is superior to the standard one-dimensional or M-mode echocardiogram for diagnosis of myxoma in that it can evaluate simultaneously both right and left atria, can detect smaller space-occupying lesions because of better resolution and can more readily determine the size of the lesion and its stalk, can evaluate the mobility of the tumor and can determine more accurately the extent of tumor obstruction. Because of these qualities, we have relied on two-dimensional echocardiography as the definitive diagnostic procedure for detection of atrial myxoma. Currently operation for atrial myxoma is performed without cardiac catheterization or angiocardiography.     

Anesthetic management of a patient with right ventricular myxoma]

Right ventricular myxoma in a 79 year old male, whose pulmonary trunk was obstructed by the myxoma, was reported. Myxoma of the heart is rare, and especially right ventricular myxoma is rare. Myxomas of the heart have been reported by thirty-seven authors, but right ventricular myxoma has been reported by only one author. Anesthesia for the removal of right ventricular myxoma must be carried out carefully, because some critical troubles may happen during anesthesia for the resection of the right ventricular myxoma. Particularly, occlusion of the pulmonary artery is the most dangerous complication.     

Adrenocortical Carcinoma with Intracaval Extension to the Right Atrium: Resection on Cardiopulmonary Bypass

Case Presentation  

A 28-year-old woman presented with dyspnea on exertion and elevated testosterone level. A 21 × 19 cm right adrenal mass was found invading the liver and inferior vena cava (IVC); tumor thrombus extended to the right atrium on transthoracic echocardiogram.     

Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease

Background

Atrial myxomas are the most common primary cardiac tumors. They are usually small or moderate in size by the time of the diagnosis, exhibiting non specific cardiac or systemic symptoms, and are most frequently soft and friable without microscopic signs of ossification. We describe herein an extremely rare case of an asymptomatic giant left atrial myxoma with angiographic neovascularization and ossification.

Case presentation

An asymptomatic 58-year-old male with a giant left atrial tumor, was transferred to our Unit for surgical treatment. The tumor was an incidental finding during a work-up for hemoptysis due to bronchectasis. The coronary angiogram showed tumor vessels originating from the RCA. The tumor macroscopically did not resemble a myxoma, considering its dimensions (12 × 10 cm) and its solid substance. The mass was excised together with the interatrial septum and the right lateral LA wall close to the right pulmonary veins orifices. The defect was closed with Dacron patches in order to prevent malformation of both atria. The pathology study revealed a benign myxoma with excessive osteoid (mature bone) content.

Conclusion

We consider our case as extremely rare because of the asymptomatic course despite the large size of the tumor, the blood supply from the right coronary artery and the bone formation.