574 Giant left atrial myxoma in ischaemic stroke

Abstract Aims Primary cardiac tumours are rare; most are benign, and of these, around half are myxomas, often located in the left atrium. Clinical presentation is variable. Ischaemic stroke is a rare, although real and potentially fatal, complications of cardiac myxomas. Methods and results We present a case of a 51-year-old man, ex- smoker, obese, with a history of hypertension and COPD, presented to our emergency department with right-sided hemiplegia and aphasia caused by ischaemic stroke. Brain computed tomography revealed cerebral perfusion deficit. The patient was underwent intravenous thrombolytic strategy and intubated transferred in Reanimation. TTE showed a large left atrial mass attached to the interatrial septum, with a friable appearance, suggestive of myxoma. The 2D and 3D TEE detected a giant space-occupying mass (60 × 20 mm diameter) in the left atrium, coral-like, and with a friable appearance, the most apical portion prolapsed into the left ventricle during diastole, causing fixed obstruction to flow in the left ventricular inflow tract. Computed tomography angiography (CTA) confirmed the giant mass in the left atrium. In view of the risk of imminent embolization, the emergent surgical excision of the tumour was performed. The tumour and its neck, including part of the atrial septum, were fully resected and the atrial septum was directly closed. Subsequent histopathological findings confirmed the diagnosis of atrial myxoma. Post-operative echocardiography showed no residual tumour. Symptomatic cardiac myxoma may present with one of the three classic clinical presentations of the Goodwin’s triad, which include intracardiac obstruction, constitutional symptoms, and embolism. The obstructive pattern mimics mitral or tricuspid valve disease and results from atrioventricular valve obstruction. Constitutional or systemic manifestations include fatigue, fever, weight loss, arthralgia, myalgia, erythematous rash, and laboratory findings such as anaemia and elevated ESR, CRP, and globulins. Systemic embolization from myxoma occurs in around a third of cases. Of these, the most serious is cerebrovascular embolism, which may result in cerebral stroke. In addition, embolization of coronary arteries, kidneys, intestines, and extremities can also occur. The tumour size, location, and macroscopic appearance, along with mean platelet volume and platelet count, are closely associated with embolic events. Echocardiography remains the method of choice for diagnosis and morphological characterization of myxoma. Two patterns have been established by echocardiography: round, with a solid appearance and a firm surface, and polypoid, with an irregular outline and a friable surface. The incidence of systemic embolization is higher in those with an irregular and friable surface, as well as in polypoid tumours and those that prolapse into the ventricle. Once a diagnosis of myxoma is established, surgical resection is the only effective treatment and should be performed immediately, in view of the risk of embolic complications. Conclusions With this case report, we stress the fundamental importance of echocardiography in new onset of neurological deficit to prevent potentially fatal outcomes.

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Giant left atrial myxoma presenting as cerebral embolism

Journal of Surgical Arts ◽

10.14717/jsurgarts-210209 ◽

2021 ◽

pp. 93-97

Keyword(s):

Left Atrial ◽

Heart Diseases ◽

Atrial Myxoma ◽

Cerebral Stroke ◽

Primary Tumors ◽

Mortality And Morbidity ◽

Left Atrial Myxoma ◽

Cardiac Neoplasms ◽

Systemic Embolization ◽

Rheumatic Heart

Primary cardiac neoplasms are uncommon with an overall incidence of 0.0017 to 0.02%. The majority of these tumors are benign and half of these tumors are myxomas. About 75% of them are located in the left atrium. Acute embolic cerebral stroke is major problem with increased mortality and morbidity. Embolus arising from cardiac origin costitutes about 20% of ischemic strokes. Atrial fibrillation is cause of more than 50% of cardiogenic emboli. Congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic and rheumatic heart valvular disease, dilated cardiomyopathy and endocarditis are predisposing factors for cardiogenic emboli. Emboli from primary tumors of the heart are extremely rare, with an incidence of 0.02 %. Myxoma is a potential source of systemic embolization to the brain or peripheral arteries. Thus, cerebral stroke may be the first manifestation of the presence of left atrial myxoma.

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A rare association of left atrial myxoma with rheumatic mitral stenosis

Case Reports in Internal Medicine ◽

10.5430/crim.v4n1p25 ◽

2016 ◽

Vol 4 (1) ◽

pp. 25

Author(s):

Satyanarayana R Vaidya ◽

Santhosh R Devarapally

Keyword(s):

Left Atrium ◽

Mitral Stenosis ◽

Left Atrial ◽

Atrial Myxoma ◽

Atrial Septum ◽

Cardiac Tumors ◽

Primary Tumors ◽

Left Atrial Myxoma ◽

Rare Association ◽

Rheumatic Mitral Stenosis

Primary cardiac tumors are very rare. Atrial myxomas are the most common primary tumors and are commonly located in the left atrium. Myxomas can cause mitral valve inflow obstruction and can present with clinical signs and symptoms of mitral stenosis and the possibility of myxoma should be considered in differential diagnosis of mitral stenosis. Left atrial myxoma is rarely associated with rheumatic mitral stenosis. Transesophageal echocardiography plays a major role in the diagnosis of this tumor. We report a case of an extremely rare association between left atrial myxoma and rheumatic mitral stenosis. Because of its location and mobility, a thrombus in the left atrium may have a similar appearance to left atrial myxoma. However, a careful inspection of features of the left atrial mass may allow a diagnosis of left atrial myxoma. In our case, the site near the atrial septum, heterogeneous echogenicity, and detection of a stalk connecting the myxoma to the atrial septum were inspected. Such findings essentially exclude thrombus.

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Cerebral embolism due to left atrial myxoma in a patient presenting with chest pain and ST-segment elevation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa272 ◽

2020 ◽

Author(s):

António Fontes ◽

Nuno Dias-Ferreira ◽

Anabela Tavares ◽

Fátima Neves

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Magnetic Resonance ◽

Left Atrial ◽

Left Ventricular ◽

Atrial Myxoma ◽

Left Atrial Myxoma ◽

St Segment ◽

Wide Range ◽

St Elevation

Abstract Background Myocarditis is an uncommon, potentially life-threatening disease that presents with a wide range of symptoms. In acute myocarditis, chest pain (CP) may mimic typical angina and also be associated with electrocardiographic changes, including an elevation of the ST-segment. A large percentage (20–56%) of myxomas are found incidentally. Case summary A 62-year-old female presenting with sudden onset CP and infero-lateral ST-elevation in the electrocardiogram. The diagnosis of ST-elevation myocardial infarction was presumed and administered tenecteplase. The patient was immediately transported to a percutaneous coronary intervention centre. She complained of intermittent diplopia during transport and referred constitutional symptoms for the past 2 weeks. Coronary angiography showed normal arteries. The echocardiogram revealed moderate to severe left ventricular systolic dysfunction due to large areas of akinesia sparing most of the basal segments, and a mobile mass inside the left atrium attached to the septum. The cardiac magnetic resonance (CMR) suggested the diagnosis of myocarditis with concomitant left atrial myxoma. The patient underwent resection of the myxoma. Neurological evaluation was performed due to mild vertigo while walking and diplopia in extreme eye movements. The head magnetic resonance imaging identified multiple infracentimetric lesions throughout the cerebral parenchyma compatible with an embolization process caused by fragments of the tumour. Discussion Myocarditis can have various presentations may mimic acute myocardial infarction and CMR is critical to establish the diagnosis. Myxoma with embolic complications requires emergent surgery. To the best of our knowledge, this is the first case reported in the applicable literature of a myxoma diagnosed during a myocarditis episode.

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Recurred Left Atrial and Left Ventricular Myxoma after Surgical Excision of Biatrial Atrial Myxoma

Korean Circulation Journal ◽

10.4070/kcj.1996.26.5.1074 ◽

1996 ◽

Vol 26 (5) ◽

pp. 1074

Author(s):

Man Young Lee ◽

Jang Seong Chae ◽

Gil Hwan Lee ◽

Dong Heon Kang ◽

Kie Bae Seung ◽

...

Keyword(s):

Left Atrial ◽

Surgical Excision ◽

Left Ventricular ◽

Atrial Myxoma

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1112 Discovering the origin of a mysterious heart cavity

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.657 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

V Vidal Urrutia ◽

P Garcia Gonzalez ◽

J L Perez Bosca ◽

D Escribano Alarcon ◽

J M Simon Machi ◽

...

Keyword(s):

Left Ventricle ◽

Left Atrium ◽

Left Atrial ◽

Left Atrial Appendage ◽

Contrast Echocardiography ◽

Left Ventricular ◽

Atrial Appendage ◽

Invasive Approach ◽

Cardiovascular Morbidity And Mortality ◽

Doppler Color

Abstract Left atrial appendage aneurysm is an infrequent cardiac malformation, with less than 150 cases reported in the literature. It is a congenital anomaly in the majority of cases, related to a dysplasia of pectinate muscles and atrial muscle bands, which tends to grow with age. At the present time, and despite of being not considered in current guidelines, surgical resection is the standard of treatment in the current literature, even in asymptomatic cases, based on cardiovascular morbidity and mortality by predisposing to atrial tachyarrhythmia, thromboembolism, and other rare conditions as coronary or left ventricular compression and rupture of the aneurysm. We report the case of a 53-year-old male patient presenting an episode of supraventricular paroxysmal tachycardia with the casual finding of a mysterious cavity in the transthoracic echocardiography. We found out the presence of a 50 mm cavity adjacent to the left atrium and left ventricle, with a bidirectional blood flow between the left atrium and the cavity when applying Doppler color and with contrast echocardiography. Given this finding, several differential diagnosis had to be considered, including vascular and structural disorders. In order to clarify the diagnosis, a cardiac magnetic resonance was performed. It revealed the presence of a huge aneurysm of the left atrial appendage (50 x 53 mm) causing a mild compression of the left ventricle, with no thrombus and no other significant findings. Due to its size, the compression of the left ventricle and the history of atrial arrhythmia we decided to manage it with an invasive approach by performing a middle thoracotomy, in order to prevent potentially serious complications. Abstract 1112 Figure. CMR 3D reconstruction; echocardiography

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The Accuracy of Left Ventricular and Left Atrial Volumetry Using 64-Slice Computed Tomography

Journal of Computer Assisted Tomography ◽

10.1097/rct.0000000000000773 ◽

2018 ◽

Vol 42 (5) ◽

pp. 754-759 ◽

Cited By ~ 1

Author(s):

Vesa Järvinen ◽

Valtteri Uusitalo ◽

Tuula Tolvanen ◽

Antti Saraste ◽

Jouni Kuusisto ◽

...

Keyword(s):

Computed Tomography ◽

Left Atrial ◽

Left Ventricular

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P4379Pathophysiology of left atrial filling in mitral regurgitation. A new volumetric flow rate index describing disturbed left atrial filling behavior in mitral regurgitation by 3D TTE

European Heart Journal ◽

10.1093/eurheartj/ehz745.0784 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Frumkin ◽

K Stangl ◽

A Muegge ◽

T Buck ◽

B Plicht

Keyword(s):

Mitral Regurgitation ◽

Left Atrium ◽

Flow Rate ◽

Left Atrial ◽

Volume Overload ◽

Volumetric Flow Rate ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Mean Flow ◽

Flow Rates

Abstract Background In chronic mitral regurgitation (MR) the left atrium (LA) is one of the first cardiac structures involved in remodeling by progressive volume overload. Real-time three-dimensional echocardiography is able to monitor volumetric changes of the left atrium during the heart cycle. Purpose We hypothesized that chronic volume overload due to MR leads to detectable changes in the LA filling behavior described by mean and maximum filling flow rates and their relation called volumetric flow rate index. Methods We prospectively analyzed data of 36 patients in different stages of chronic MR and 13 patients without MR. Transthoracic echocardiography was conducted using the Epiq 7G Ultrasound System. Standard 2D- and 3D apical 4-chamber views were recorded and stored for offline analysis. We generated volume-time-curves by 3D volume analysis to derive mean and maximum volumetric flow rates during LA reservoir, conduit and pump phase. Volumetric flow rate index was calculated as the quotient of mean flow rate/maximum flow rate. Results Average MR severity, calculated with the MR Scoring system introduced from Buck et al. and implicated in the ESC Guidelines, was 6.2 points (±2.5) according to Grade I-II. We included 13 patients without MR, 18 with mild MR, 12 patients with moderate MR, 6 patients with severe MR. Left ventricular ejection fraction was similar in the different groups (51,2±12,3%). Maximum and mean flow rate showed no significant correlation with MR severity. Correlation of MR severity with LA dilation (ml/m2 BSA) was r=0.41; p<0.001. Flow rate index showed strong significant correlation with MR severity in left atrial reservoir phase (r=−0.75; p<0.001). There was no statistically relevant difference of volumetric flow rate parameters in left atrial pump and conduit phase. Line chart Conclusions We observed a significant correlation of the volumetric flow rate index to MR severity in the left atrial reservoir phase with stronger correlation than MR severity to left atrial dilation. The results of this work encourage further investigations to establish the presented volumetric flow rate index as a progression marker of MR and to evaluate its prognostic value.

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