A left atrial hamartoma of mature cardiac myocytes

We present a case of a hamartoma of mature cardiac myocytes. This is an extremely rare tumour and the first reported paediatric case localised in the left atrium.

Paradoxical Malignant Embolism, Brief Review

During gestation period the oxygenated maternal blood is transferred to the embryo via the placenta and umbilical cord into the right atrium. It is further transferred through an interatrial shunt to the left atrium, the Foramen Ovale, and distributed to the embryonic body. The foramen is closed after the birth, but remains occasionally patent, permitting embolization through a right to left shunt. This is transferring thrombi, fat, cement and bony spikes, air, and occasionally malignant tissue. This brief review is on the malignant embolization.

Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

BackgroundThe limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic analysis on procedural success rate, atrial fibrillation (AF) recurrence rate and complications of cryoballoon ablation in association with the anatomy of the left atrium and PV based on preprocedural CT to gain insights into proper treatments of patients with AF using cryoballoon.MethodA systematic search of literature databases, including PubMed, Web of Science and Cochrane Library, from the inception of each database through February 2021 was conducted. Search keywords included ‘atrial fibrillation’, ‘cryoballoon ablation’ and ‘anatomy’.ResultsOverall, 243 articles were identified. After screening, 16 articles comprising 1396 patients were included (3, 5 and 8 for acute success, AF recurrence and complications, respectively). Regarding acute success and AF recurrences, thinner width of the left lateral ridge, higher PV ovality, PV ostium-bifurcation distance, shorter distance from the non-coronary cusp to inferior PVs, shallower angle of right PVs against the atrial septum and larger right superior PV (RSPV) were associated with poor outcomes. Regarding complications, shorter distance between the RSPV ostium and the right phrenic nerve, larger RSPV-left atrium angle, larger RSPV area and smaller right carina width were associated with incidences of phrenic nerve injury.ConclusionThis study elucidated several key anatomical features of PVs possibly affecting acute success, AF recurrence and complications in patients with AF using cryoballoon ablation. CT analysis has helped to describe benefits and anatomical limitations for cryoballoon ablation.

Primary left atrial angiosarcoma mimicking pericarditis: A case report and review of the literature

A 45-year-old male presented with symptoms mimicking pericarditis, including rapidly worsening dyspnea and retrosternal chest pain. On imaging workup, an abnormal mass of 50x53 mm in size was detected at the left atrium, which partially obstructed blood flow through the mitral valve. PET/CT was done in searching for the probable site of origin but revealed no abnormal uptake lesions. The tumorectomy and excision of the posterior wall of the left atrium were then performed with curative intent. The postoperative histology of the tumor was in favor of a spindle cell sarcoma, originating from the left atrium, grade 2, which was confirmed as epithelioid angiosarcoma by immunohistochemistry. The patient denied adjuvant radiation, thus we treated him with six cycles of Paclitaxel monotherapy, which was completed six months ago. At present, he is doing well with no signs of recurrence on the imaging technique. This paper illustrates the rarity of cardiac angiosarcoma, its complex presentation, and a brief review of available treatment options for this devastating disease.