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de Quadros Schroeder A, Greggianin C, Rover MM, Benedetto IG, Butzke M, Pinotti A, Wender O. A 30-Year-Old Woman With Arthralgia, Progressive Dyspnea, and a Syncope Episode. Chest 2024; 165:e173-e176. [PMID: 38852974 DOI: 10.1016/j.chest.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 06/11/2024] Open
Abstract
CASE PRESENTATION A 30-year-old White woman with presumed rheumatoid arthritis accompanied by CT scan evidence of eosinophilic pneumonitis was referred to the ED by her rheumatologist for an investigation of the progression of dyspnea. Approximately 6 months before, the patient reported experiencing diffuse interphalangeal arthralgias (both proximal and distal) that affected the wrists, knees, and feet. These symptoms were accompanied by Modified Medical Research Council scale grade 2 dyspnea. During the initial assessment, the patient exhibited slight pallor and had no indications of inflammatory activity in the joints. Furthermore, the cardiovascular physical examination and the auto-antibody laboratory profile yielded normal results. However, a wrist ultrasound scan revealed evidence of active synovitis; a chest CT scan displayed multifocal bilateral ground-glass opacities and mild thickening of the interlobular septa. These findings suggested the presence of eosinophilic disease or an acute interstitial process related to collagen vascular disease. Consequently, the patient's treatment commenced with a weekly dose of methotrexate (10 mg). Despite the intervention, 2 months later, the patient returned, reporting persistent arthralgia and a worsening of dyspnea, now classified as Modified Medical Research Council scale grade 3. Subsequently, the rheumatologist referred her to the ED for further assessment. During the initial emergency evaluation, the patient experienced a syncope episode accompanied by orthostatic prodromal symptoms that included dizziness, nausea, and malaise.
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Affiliation(s)
| | - Camila Greggianin
- Division of Thoracic Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Marciane Maria Rover
- Emergency Department, Hospital Moinhos de Vento and Instituto de Cardiologia, Porto Alegre, RS, Brazil
| | - Igor Gorski Benedetto
- Division of Respirology, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Mauricio Butzke
- Emergency Department, Instituto de Cardiologia and Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Antonio Pinotti
- Department of Echocardiography, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Orlando Wender
- Division of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Otchere P, Pak S, Ulloa-Rodriguez J, Fierro M, Sharma A, Poku T, Kofi-Obeng B, Yang E, Thallapureddy K. Complex decision making in a patient with lung cancer with incidentally found fast-growing atrial mass. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:30. [PMID: 38762470 PMCID: PMC11102299 DOI: 10.1186/s40959-024-00219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/11/2024] [Indexed: 05/20/2024]
Abstract
Atrial myxomas are typically found in the left atrium and are the most common among overall rare cardiac tumors. Herein, we describe the clinical course of a 72-year-old female with non-small cell lung adenocarcinoma found to have an atrial mass during an imaging for evaluation for lung cancer progression. Differentiating between distinct types of masses can pose a challenge to the treatment team especially in the setting of exiting malignancy. This case demonstrates the complex decision making involved in the diagnosis, and timing of intervention to remove atrial mass in patients with frailty and a fast-growing cardiac mass.
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Affiliation(s)
- Prince Otchere
- Department of Cardio-Oncology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Stella Pak
- Department of Neurology, Albany Medical Center, 43 New Scotland Ave, Albany, NY, 12208, USA.
| | - Juan Ulloa-Rodriguez
- Department of Cardiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Maria Fierro
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Aditi Sharma
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Tevonne Poku
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Eric Yang
- Department of Cardiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Keerthi Thallapureddy
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX, USA
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3
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Bennani G, Atlas I, Zahri S, Haboub M, Drighil A, Habbal R. [Association of a myxoma of the left atrium and a mitral stenosis : About a case]. Ann Cardiol Angeiol (Paris) 2024; 73:101719. [PMID: 38266406 DOI: 10.1016/j.ancard.2023.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/28/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Atrial myxoma is a rare and benign clinical entity. It remains common in women and mainly affects the left atrium. Its clinical picture is polymorphic. We report the case of a 53-year-old woman who consulted for dyspnea with cardiac failure's picture. The diagnosis of myxoma of the left atrium was made on echocardiography which also objectified the existence of mitral stenosis. The patient underwent surgical excision and mitral valve replacement with good postoperative outcomes.
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Affiliation(s)
- G Bennani
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc.
| | - I Atlas
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - S Zahri
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - M Haboub
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - A Drighil
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
| | - R Habbal
- Service de cardiologie du CHU IBN ROCHD, Casablanca, Maroc
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Oktaviono YH, Saputra PBT, Arnindita JN, Afgriyuspita LS, Kurniawan RB, Pasahari D, Milla C, Wungu CDK, Susilo H, Multazam CECZ, Alkaff FF. Clinical characteristics and surgical outcomes of cardiac myxoma: A meta-analysis of worldwide experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107940. [PMID: 38219702 DOI: 10.1016/j.ejso.2023.107940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
Cardiac myxoma is the most common primary cardiac tumor. However, existing literature mainly consists of single-center experiences with limited subjects. This systematic review aimed to provide data on clinical characteristics and surgical outcomes of cardiac myxoma. We performed a thorough literature search on May 23, 2023 on PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science. The inclusion criteria were English full-text, observational studies, and included >20 subjects. From the search, 112 studies with a total of 8150 patients were included in the analysis. The mean age was 51 years (95 % confidence interval [95%CI] = 49.1-52.3), and the majority were females (64.3 % [95 % CI = 62.8-65.8 %]). The most common clinical manifestation was cardiovascular symptoms. Echocardiography can diagnose almost all cases (98.1 % [95 % CI = 95.8-99.6 %]). Cardiac myxoma was mostly prevalent in left atrium (85.3 % [95%CI = 83.3-87 %]) and predominantly with pedunculated morphology (75.6 % [95%CI = 64.1-84.3 %]). Post-tumor excision outcomes were excellent, with an early mortality of 1.27 % (95 % CI = 0.8-1.8 %), late mortality rate of 4.7 (95 % CI = 2.5-7.4) per 1000 person-years, and recurrence rate at 0.5 (95 % CI = 0.0-1.1) per 1000 person-years. Tumor excision is warranted in a timely manner once the cardiac myxoma diagnosis is established.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Jannatin Nisa Arnindita
- Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia; Faculty of Medicine, Universitas Airlangga, Indonesia
| | | | | | - Diar Pasahari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia
| | - Clonia Milla
- Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | | | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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5
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Côrte-Real F, Côrte-Real H. The Role of Transesophageal Echocardiogram in the Diagnosis and Treatment of Intracardiac Tumors: A Case of Atrial Myxoma. Cureus 2024; 16:e53597. [PMID: 38449977 PMCID: PMC10915702 DOI: 10.7759/cureus.53597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
Cardiac myxoma is the most common primary heart tumor in adults. Although biologically benign, they can be life-threatening by obstructing heart function. They typically develop in the left atrium and can be polypoid (causing more obstruction) or papillary (more likely to cause embolizations). Symptoms are nonspecific, and diagnosis is relatively rare. Echocardiography is essential for quick diagnosis, and surgical removal is the primary treatment with low mortality rates, excellent postoperative survival, and low recurrence rates. We report a 73-year-old woman presented to the emergency room with extreme fatigue and weight loss. Further investigations revealed a mass in the left atrium suggestive of an intracardiac tumor on a thoracic computer tomography scan. A subsequent transesophageal echocardiogram was performed, which showed a large, mobile, and friable hyperechogenic intra-auricular mass adhered to the atrial septum with moderate mitral regurgitation and moderate aortic stenosis. This case highlights the crucial role that the transesophageal echocardiogram plays in these patients by accelerating diagnosis, assisting with myxoma resolution, and confirming the complete removal of the myxoma.
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Affiliation(s)
- Filipa Côrte-Real
- Intensive Care Department, Hospital Central do Funchal, Funchal, PRT
| | - Hugo Côrte-Real
- Intensive Care Department, Hospital Santa Maria, Lisbon, PRT
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6
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Ale P, Gurung A, Hargroves D, Omojowolo O. Atrial myxoma: A cause for concern in multiple cerebral infarctions in absence of cardiac symptoms. BMJ Case Rep 2023; 16:e257157. [PMID: 38011961 PMCID: PMC10685979 DOI: 10.1136/bcr-2023-257157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Ischaemic cerebral infarct is the most common neurological manifestation of myxomas. We present a mid-70s man who was brought to the stroke unit with sudden onset right hemiparesis and dysarthria. Although he had risk factors for developing stroke like hypertension, hypercholesterolaemia, history of prostate cancer and new paroxysmal atrial flutter on admission, clinical suspicion and detailed investigations in the absence of cardiac symptoms revealed a 9 cm myxoma causing severe mitral stenosis. He underwent successful surgical resection with good functional recovery. This also highlights the need for thorough clinical examination especially in the absence of cardiac symptoms.
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Affiliation(s)
- Pramol Ale
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
| | - Abinas Gurung
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
| | - David Hargroves
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
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Umadat G, Rohm C, Reddy P, Parikh P, Ray J, Gharacholou SM, El Sabbagh A. Percutaneous Removal of Left Atrial Myxoma: The FLORIDA Procedure. JACC Case Rep 2023; 24:102013. [PMID: 37869219 PMCID: PMC10589418 DOI: 10.1016/j.jaccas.2023.102013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/24/2023]
Abstract
Surgical resection has been the treatment of choice for cardiac myxomas, but older age and comorbidities relegate many patients to observation. Pure percutaneous removal of left atrial myxomas is both intriguing and challenging. We report a successful percutaneous technique for removal of left atrial cardiac myxoma in a nonsurgical candidate. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Goyal Umadat
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | - Charlene Rohm
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | - Prajwal Reddy
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | - Pragnesh Parikh
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | - Jordan Ray
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Abdallah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
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8
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Khan MQA, Zaheer A, Yasir SB, Fatima R, Anand A. Management of calcified right atrial myxoma extending into the inferior vena cava: a case report. J Surg Case Rep 2023; 2023:rjad568. [PMID: 37854527 PMCID: PMC10581705 DOI: 10.1093/jscr/rjad568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023] Open
Abstract
Cardiac myxomas can rarely involve the right atrium, get calcified and involve the inferior vena cava (IVC). Early surgical intervention is critical to prevent life-threatening complications. We presented the case of a 39-year-old male with fever, cough and shortness of breath for 1 week. Initial laboratory investigations revealed leucocytosis and thrombocytopenia. His electrocardiogram was normal, and his chest X-ray showed bilateral infiltrates. Based on the findings of a high-resolution chest computed tomography scan, echocardiography and cardiac magnetic resonance imaging, we made a provisional diagnosis of calcified right atrial myxoma extending up to the IVC. We managed the case with cardiopulmonary bypass via aortic cannulation followed by a right atriotomy. Post-operatively, the patient's condition improved and was doing well on monthly follow-ups.
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Affiliation(s)
| | - Amna Zaheer
- Liaquat National Hospital and Medical College, Karachi 75300, Pakistan
| | - Sarib Bin Yasir
- Liaquat National Hospital and Medical College, Karachi 75300, Pakistan
| | - Ramsha Fatima
- Liaquat National Hospital and Medical College, Karachi 75300, Pakistan
| | - Ayush Anand
- B. P. Koirala Institute of Health Sciences, Dharan 56700, Nepal
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9
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Martin SJ, Maxey-Jones C, Zhou Z, Nazem A, Cherney A, Lutz CJ. Robot-Assisted Excision of a Left Ventricular Myxoma and Hemangioma. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:506-508. [PMID: 37786985 DOI: 10.1177/15569845231199741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Left ventricular masses are rare entities that often require surgical excision when diagnosed due to the risk of embolization. We report 2 separate patients presenting with evidence of cerebral embolization both of whom were diagnosed with isolated left ventricular masses and underwent surgical excision through a robot-assisted approach. Microscopic pathology revealed a myxoma and hemangioma, respectively. Both cases demonstrate that left ventricular masses can be feasibly excised through a robot-assisted minithoracotomy approach.
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10
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Kelleher AB, Ní Dhonnchu T, Vaughan C, O'Connor TM. Easy to miss large left atrial myxoma. BMJ Case Rep 2023; 16:e255616. [PMID: 37607762 PMCID: PMC10445385 DOI: 10.1136/bcr-2023-255616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
| | | | - Carl Vaughan
- Cardiology, Mercy University Hospital, Cork, Ireland
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11
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Rout A, Vorla M, Aromiwura AA, Pahwa SV, Stoddard MF, Slaughter MS, Kalra DK. A Rapidly Growing Cardiac Mass-Malignant or Benign? CASE (PHILADELPHIA, PA.) 2023; 7:321-324. [PMID: 37614692 PMCID: PMC10442374 DOI: 10.1016/j.case.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•Rapidly growing cardiac tumors can be benign or malignant. •Rarely, cardiac myxomas may grow rapidly, causing heart failure or obstructive symptoms. •Echocardiography remains the first-line imaging for cardiac tumors. •Multimodality imaging with CCT, CMR, and PET may aid in diagnosis.
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Affiliation(s)
- Amit Rout
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | - Mounica Vorla
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | | | - Siddharth V. Pahwa
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | | | - Mark S. Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville, Louisville, Kentucky
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Zhou M, Yao Y, Wang X, Zha L, Chen Y, Li Y, Wang M, Yu C, Zhou Y, Li Q, Cao Z, Wu J, Shi S, Jiang D, Long D, Wang J, Wang Q, Cheng X, Liao Y, Tu X. Crosstalk between KIF1C and PRKAR1A in left atrial myxoma. Commun Biol 2023; 6:724. [PMID: 37452081 PMCID: PMC10349109 DOI: 10.1038/s42003-023-05094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Cardiac myxoma (CM) is the most common benign cardiac tumor, and most CMs are left atrial myxomas (LAMs). Six variations of KIF1C, c.899 A > T, c.772 T > G, c.352 A > T, c.2895 C > T, c.3049 G > A, and c.*442_*443dup in left atrial myxoma tissues are identified by whole-exome sequencing (WES) and Sanger sequencing. RNA-seq and function experiments show the reduction of the expression of KIF1C and PRKAR1A caused by rare variations of KIF1C. KIF1C is observed to be located in the nucleus, bind to the promoter region of PRKAR1A, and regulate its transcription. Reduction of KIF1C decreases PRKAR1A expression and activates the PKA, which causes an increase in ERK1/2 phosphorylation and SRC-mediated STAT3 activation, a reduction of CDH1, TP53, CDKN1A, and BAX, and eventually promotes tumor formation both in vitro and in vivo. The results suggest that inhibition of KIF1C promotes the pathogenesis of LAM through positive feedback formed by the crosstalk between KIF1C and PRKAR1A.
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Affiliation(s)
- Mengchen Zhou
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
- National Demonstration Center for Experimental Basic Medical Education, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Xiangyi Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Lingfeng Zha
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yilin Chen
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yanze Li
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Mengru Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Chenguang Yu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yingchao Zhou
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Qianqian Li
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Zhubing Cao
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Jianfei Wu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Shumei Shi
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Dan Jiang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Qing Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xiang Cheng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuhua Liao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Xin Tu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Center for Human Genome Research, Cardio-X Institute, Huazhong University of Science and Technology, Wuhan, 430074, China.
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Aluthman U, Ashour MA, Bafageeh SW, Chandrakumaran A, Alrehaili TS, Abdulrahman OA, Elmahrouk AF, Alaamri S, AlGhamdi SA, Jamjoom AA. Minimally-invasive approach via percutaneous femoral cannulation for the resection of intra-cardiac masses: a single center experience in the Middle-East. J Cardiothorac Surg 2023; 18:203. [PMID: 37400815 DOI: 10.1186/s13019-023-02295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Intra-cardiac masses are rare and challenging lesions with an overall incidence ranging of 0.02-0.2%. Minimally invasive approaches have been recently introduced for surgical resection of these lesions. Here, we evaluated our early experience using minimally invasive techniques in addressing intra-cardiac lesions. METHODOLOGY This is a retrospective descriptive study conducted between April 2018 to December 2020. All patients were diagnosed with cardiac tumors and treated via a right mini-thoracotomy with cardiopulmonary bypass through femoral cannulation at King Faisal Specialist Hospital and Research Centre, Jeddah. RESULTS Myxoma was the most common pathology representing 46% of cases followed by thrombus (27%), leiomyoma (9%), lipoma (9%) and angiosarcoma (9%). All tumors were resected with negative margins. One patient was converted to open sternotomy. Tumor locations were in the right atrium, left atrium, and left ventricle in 5, 3, and 3 patients, respectively. The median ICU stay was 1.33 days. The median length of hospitalization was 5.7 days. There was no 30-days hospital mortality recorded in this cohort. CONCLUSION Our early experience shows that minimally invasive resection can be performed safely and effectively for intra-cardiac masses. The minimally invasive approach using a mini-thoracotomy with percutaneous femoral cannulation can be an effective alternative in resecting intra-cardiac masses that achieves clear margin resection, quick post-operative recovery, and low rates of recurrence for benign lesions.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia.
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | | | | | | | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia
| | - Shalan Alaamri
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia
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14
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Kurnick A, Burkhanova U, Friedman A, John S, Bukharovich I. A Rare Case of Massive Left Atrial Myxoma Presenting as Syncope. Cureus 2023; 15:e41249. [PMID: 37529806 PMCID: PMC10388804 DOI: 10.7759/cureus.41249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
We report a rare case of a large left atrial myxoma that manifested as syncope in a patient who presented to the hospital following a syncopal episode. Our patient had a history of hypertension and anemia with reported two months of dyspnea on exertion. He was found to have a large left atrial myxoma. Atrial myxomas are the most common benign primary cardiac tumors. Patients may be asymptomatic or experience shortness of breath, palpitations, syncope, or sudden death. Cases of syncope caused by left atrial myxoma have been rarely documented. Our case report adds to the growing literature documenting this phenomenon. Larger observational studies are needed to properly define the incidence of left atrial myxoma causing syncope.
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Affiliation(s)
- Adam Kurnick
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Umida Burkhanova
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Adam Friedman
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
- Department of Cardiology, Kings County Hospital, Brooklyn, USA
| | - Inna Bukharovich
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
- Department of Cardiology, Kings County Hospital, Brooklyn, USA
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15
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Kurmann R, El-Am E, Ahmad A, Abbasi MA, Mazur P, Akiki E, Anand V, Herrmann J, Casanegra AI, Young P, Crestanello J, Bois MC, Maleszewski JJ, Klarich K. Cardiac Masses Discovered by Echocardiogram; What to Do Next? STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100154. [PMID: 37520139 PMCID: PMC10382990 DOI: 10.1016/j.shj.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 02/12/2023]
Abstract
Cardiac tumors are rare conditions, typically diagnosed on autopsy, but with the advancement of imaging techniques they are now encountered more frequently in clinical practice. Echocardiography is often the initial method of investigation for cardiac masses and provides a quick and valuable springboard for their characterization. While some cardiac masses can be readily identified by echocardiography alone, several require incorporation of multiple data points to reach diagnostic certainty. Herein, we will provide an overview of the main clinical, diagnostic, and therapeutic characteristics of cardiac masses within the framework of their location.
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Affiliation(s)
- Reto Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elias Akiki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ana I. Casanegra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie C. Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J. Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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16
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Gao A, Yang J, Tian T, Wu Y, Sun X, Qi N, Tian N, Wang X, Wang J. Visual analysis based on CiteSpace software: a bibliometric study of atrial myxoma. Front Cardiovasc Med 2023; 10:1116771. [PMID: 37252126 PMCID: PMC10213645 DOI: 10.3389/fcvm.2023.1116771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To use CiteSpace and VOSviewer visual metrology to analyze the research status, frontier hotspots, and trends in research on atrial myxoma. Methods The Web of Science core collection database was used to retrieve relevant literature on atrial myxoma from 2001 to 2022. CiteSpace software was used to analyze keywords with a co-occurrence network, co-polymerization class, and burst terms, and a corresponding visual atlas was drawn for analysis. Results A total of 893 valid articles were included. The country with the highest number of articles was the United States (n = 186). The organization with the highest number of articles was the Mayo Clinic (n = 15). The author with the highest number of articles was Yuan SM (n = 12). The highest cited author was Reynen K (n = 312). The highest cited journal was Annals of Thoracic Surgery (n = 1,067). The most frequently cited literature was published in the New England Journal of Medicine in 1995, which was cited 233 times. The keywords co-occurrence, copolymerization analysis, and Burst analysis revealed that the main research focuses were surgical methods, case reports, and genetic and molecular level studies on the pathogenesis of myxoma. Conclusions This bibliometric analysis revealed that the main research topics and hotspots in atrial myxoma included surgical methods, case reports, genetic and molecular studies.
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Affiliation(s)
- Ang Gao
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jinghua Yang
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tongru Tian
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Wu
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoting Sun
- Department of Orthopedics, Zhengzhou Orthopedic Hospital, Zhengzhou, China
| | - Na Qi
- Department of Encephalology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Nan Tian
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Department of Internal Medicine-Cardiovascular, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jisheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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17
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Van Praet KM, Kofler M, Wilkens K, Sündermann SH, Meyer A, Hommel M, Jacobs S, Falk V, Kempfert J. Minimally Invasive Extirpation of Benign Atrial Cardiac Tumors: Clinical Follow-Up and Survival. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023:15569845231170000. [PMID: 37144727 DOI: 10.1177/15569845231170000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Evidence determining the optimal treatment for cardiac tumors is rare. We report our midterm clinical outcome and patient characteristics of our series undergoing atrial tumor removal through a right lateral minithoracotomy (RLMT). METHODS From 2015 to 2021, 51 patients underwent RLMT for atrial tumor extirpation. Patients receiving concomitant atrioventricular valvular, cryoablation, and/or patent foramen ovale closure surgery were included. Follow-up was performed using standardized questionnaires (mean: 1,041 ± 666 days). Follow-up involved any tumor recurrence, clinical symptoms, and any recurrent arterial embolization. Survival analysis was successfully achieved in all patients. RESULTS Successful surgical resection was achieved in all patients. Mean cardiopulmonary bypass and cross-clamping times were 75 ± 36 and 41 ± 22 min, respectively. The most common tumor location was the left atrium (n = 42, 82.4%). Mean ventilation time was 12.74 ± 17.23 h, intensive care unit stay ranged from 1 to 1.9 days (median: 1 day). Nineteen patients (37.3%) received concomitant surgery. Histopathological analysis showed 38 myxoma (74.5%), 9 papillary fibroelastoma (17.6%), and 4 thrombus (7.8%). Thirty-day mortality was observed in 1 case (2%). One patient (2%) suffered a stroke postoperatively. No patient had a relapse of cardiac tumor. Three patients (9.7%) showed arterial embolization during follow-up. Thirteen follow-up patients (25.5%) were in New York Heart Association class ≤II. Overall survival was 90.2% at 2 years. CONCLUSIONS A minimally invasive approach for benign atrial tumor resection is effective, safe, and reproducible. Of the atrial tumors, 74.5% were myxoma and 82% were located in the left atrium. A low 30-day mortality rate with no manifestation of recurrent intracardiac tumor was observed.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Kristin Wilkens
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Matthias Hommel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
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18
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Moskal P, Kubicz E, Grudzień G, Czerwiński E, Dulski K, Leszczyński B, Niedźwiecki S, Stępień EŁ. Developing a novel positronium biomarker for cardiac myxoma imaging. EJNMMI Phys 2023; 10:22. [PMID: 36959477 PMCID: PMC10036702 DOI: 10.1186/s40658-023-00543-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Cardiac myxoma (CM), the most common cardiac tumor in adults, accounts for 50-75% of benign cardiac tumors. The diagnosis of CM is often elusive, especially in young stroke survivors and transthoracic echocardiography (TTE) is the initial technique for the differential diagnostics of CM. Less invasive cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are not available for the majority of cardiac patients. Here, a robust imaging approach, ortho-Positronium (o-Ps) imaging, is presented to determine cardiac myxoma extracted from patients undergoing urgent cardiac surgery due to unexpected atrial masses. We aimed to assess if the o-Ps atom, produced copiously in intramolecular voids during the PET imaging, serves as a biomarker for CM diagnosing. METHODS Six perioperative CM and normal (adipose) tissue samples from patients, with primary diagnosis confirmed by the histopathology examination, were examined using positron annihilation lifetime spectroscopy (PALS) and micro-CT. Additionally, cell cultures and confocal microscopy techniques were used to picture cell morphology and origin. RESULTS We observed significant shortening in the mean o-Ps lifetime in tumor with compare to normal tissues: an average value of 1.92(02) ns and 2.72(05) ns for CM and the adipose tissue, respectively. Microscopic differences between tumor samples, confirmed in histopathology examination and micro-CT, did not influenced the major positronium imaging results. CONCLUSIONS Our findings, combined with o-Ps lifetime analysis, revealed the novel emerging positronium imaging marker (o-PS) for cardiovascular imaging. This method opens the new perspective to facilitate the quantitative in vivo assessment of intracardiac masses on a molecular (nanoscale) level.
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Affiliation(s)
- Paweł Moskal
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
| | - Ewelina Kubicz
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
| | - Grzegorz Grudzień
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Eryk Czerwiński
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Kamil Dulski
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Bartosz Leszczyński
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
| | - Szymon Niedźwiecki
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Ewa Ł Stępień
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
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19
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Qiao ML, Ma L, Wang CB, Fang LB, Fan ZX, Niu TT, Wang ZY, Lu JF, Yuan BY, Liu GZ. Clinical features, risk factors and survival in cardiac myxoma-related ischemic stroke: A multicenter case-control study. J Neurol Sci 2023; 444:120517. [PMID: 36528975 DOI: 10.1016/j.jns.2022.120517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac myxoma (CM) is an important etiology of stroke in young adults, but studies on CM-related ischemic stroke (CM-IS) are limited and conflicting. Hence, we investigated clinical characterizations, risk factors of CM-IS, and short-term survival after surgical resection. METHODS We performed a retrospective analysis of data from all CM patients at three referral management centers and conducted follow-up examination. RESULTS Among 414 CM patients, 402 were recruited for further analysis, including 54 patients with CM-IS and 348 patients with CM without stroke (Non-stroke). In the acute phase, patients presented with NIHSS 3 (interquartile range: 0-10) and clinical presentation comprising neurological, cardiac and constitutional symptoms. Multivariate analysis showed that the factors associated with an increased risk of CM-IS were tumor width < 30 mm [OR = 2.652, 95% CI: 1.061-6.627, P = 0.037], tumors with high-mobility (OR = 2.700, 95% CI: 1.357-5.371, P = 0.005), thrombus on the tumor surface (OR = 1.856, 95% CI: 1.003-3.434, P = 0.049), and lower B-type natriuretic peptide (BNP) levels (OR = 0.995, 95% CI: 0.989-0.999, P = 0.047). The overall three-year survival rate was 95.7% (95% CI: 94.9-96.5) in CM-IS patients who underwent surgery. CONCLUSIONS CM-IS patients had mild or moderate neurologic deficits with various presentations at disease onset. Narrower tumor width, tumors with high-mobility, thrombus on the tumor surface, and lower BNP levels are potential predictors of CM-IS development. Surgical removal of CM is safe and efficacious in patients with CM-IS.
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Affiliation(s)
- Man-Li Qiao
- Department of General Practice Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Lin Ma
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Chao-Bin Wang
- Department of Neurology, Beijing Fangshan district Liangxiang Hospital, Beijing 102400, China
| | - Li-Bo Fang
- Department of Neurology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100029, China
| | - Ze-Xin Fan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Tian-Tong Niu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Ze-Yi Wang
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jian-Feng Lu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Bo-Yi Yuan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Guang-Zhi Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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20
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Ma L, Cai B, Qiao ML, Fan ZX, Fang LB, Wang CB, Liu GZ. Risk factors assessment and a Bayesian network model for predicting ischemic stroke in patients with cardiac myxoma. Front Cardiovasc Med 2023; 10:1128022. [PMID: 37034338 PMCID: PMC10079949 DOI: 10.3389/fcvm.2023.1128022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective This study aims to identify relevant risk factors, assess the interactions between variables, and establish a predictive model for ischemic stroke (IS) in patients with cardiac myxoma (CM) using the Bayesian network (BN) approach. Methods Data of patients with CM were collected from three tertiary comprehensive hospitals in Beijing from January 2002 to January 2022. Age, sex, medical history, and information related to CM were extracted from the electronic medical record system. The BN model was constructed using the tabu search algorithm, and the conditional probability of each node was calculated using the maximum likelihood estimation method. The probability of each node of the network and the interrelationship between IS and its related factors were qualitatively and quantitatively analyzed. A receiver operating characteristic (ROC) curve was also plotted. Sensitivity, specificity, and area under the curve (AUC) values were calculated and compared between the BN and logistic regression models to evaluate the efficiency of the predictive model. Results A total of 416 patients with CM were enrolled in this study, including 61 with and 355 without IS. The BN model found that cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility were directly associated with the occurrence of IS in patients with CM. The BN model for predicting CM-IS achieved higher scores on AUC {0.706 [95% confidence interval (CI), 0.639-0.773]} vs. [0.697 (95% CI, 0.629-0.766)] and sensitivity (99.44% vs. 98.87%), but lower scores on accuracies (85.82% vs. 86.06%) and specificity (6.56% vs. 11.48%) than the logistic regression model. Conclusion Cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility are candidate predictors of IS in patients with CM. The BN model was superior or at least non-inferior to the traditional logistic regression model, and hence is potentially useful for early IS detection, diagnosis, and prevention in clinical practice.
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Affiliation(s)
- Lin Ma
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bin Cai
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Man-Li Qiao
- Department of General Practice Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ze-Xin Fan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Li-Bo Fang
- Department of Neurology, Beijing Fangshan District Liangxiang Hospital, Beijing, China
| | - Chao-Bin Wang
- Department of Neurology, Beijing Fuxing Hospital, Capital Medical University, Beijing, China
| | - Guang-Zhi Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Correspondence: Guang-Zhi Liu
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D’Anna C, Villani A, Ammirati A, Francalanci P, Ragni L, Cecconi G, Secinaro A, Chinali M, Santilli A, Guccione P, Galletti L, Brancaccio G. New Onset Cardiac Murmur and Exertional Dyspnea in an Apparently Healthy Child: A Rare Localization of Obstructive Myxoma in the Right Ventricle Outflow Tract without Pulmonary Embolization-A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12888. [PMID: 36232202 PMCID: PMC9566503 DOI: 10.3390/ijerph191912888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Myxomas are slowly growing benign neoplasms which are rare in children. Up to 80% can be located in the left atrium and generate symptoms such as embolism, cardiac failure, fever and weight loss. Rarely, myxomas can be detected in the right ventricle outflow tract, causing arrhythmias, pulmonary emboli and sudden death. We report the case of a 13-year-old healthy child brought to the Emergency Department (ED) of the Children's Hospital Bambino Gesù, Rome, for recent dyspnea, chest pain on exertion and new onset cardiac murmur. Patient underwent medical examination and echocardiogram with the finding of a rounded and lobulated voluminous mass in the right ventricle outflow tract (RVOT) which caused severe obstruction. The contrast computed tomography (CT) scan confirmed the presence of a heterogeneously enhancing soft-tissue mass occupying the RVOT with no evidence of pulmonary embolization. The mass was surgically excised, and the pathologic examination confirmed our suspicion of myxoma. Our experience suggests that myxoma can have mild clinical symptoms, the presentation may be non-specific, and diagnosis can be a challenge Careful examination and a diagnostic imaging workup, primarily with the transthoracic echocardiogram, are needful to make a rapid differential diagnosis and to better manage surgical treatment and follow-up.
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Affiliation(s)
- Carolina D’Anna
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonio Ammirati
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Francalanci
- Department of Pathological Anatomy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Laura Ragni
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cecconi
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Santilli
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gianluca Brancaccio
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
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22
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Alrifae GMH, Almuquddami AAS, Etaleb KM, Abdelhamid MHM. Post-Acute COVID-19 syndrome (PACS) right atrioventricular and vena cava thrombus on top of a myxoma. A Case report. J Cardiothorac Surg 2022; 17:261. [PMID: 36209231 PMCID: PMC9547375 DOI: 10.1186/s13019-022-01998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Post-Acute COVID-19 syndrome (PACS) is considered to be one of the least understood post-infectious syndromes. We report a case of a 21-year-old female who had a history of SARS-CoV-2 infection and presented with a right atrioventricular thrombus associated with pulmonary embolism and thrombocytopenia. At the time of admission, she was not vaccinated against SARS-CoV-2, and her serological tests for IgG and IgM antibodies against SARS-CoV-2 were positive. The size of the thrombus measured approximately 6 × 8 × 4 cm, which also led to tricuspid valve insufficiency due to mechanical dilatation of the valve’s ring. The right atrioventricular thrombus also extended up to the inferior vena cava, leading to mild congestive hepatomegaly. Moreover, during thrombectomy, the mass of the thrombus was attached to the interseptal right atrial wall. The histopathological assessment of the core mass revealed that it was a right atrial myxoma hidden inside that large thrombus. We suspect that the formation and propagation of the thrombus to that size occurs as a part of Post-Acute COVID-19 syndrome (PACS). This study reviews and discusses coronavirus disease 2019-relate to thrombus formation inside cardiac chambers in case of a cardiac tumor, like myxoma in the setting of post-acute phase COVID-19 syndrome.
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Affiliation(s)
| | | | | | - Mohamed Hadi Mohamed Abdelhamid
- Head of Researchs and Sciences Committees Office, National Center for Disease Control (NCDC), Tripoli, Libya. .,Department of Cell Biology and Tissue Culture, Biotechnology Research Center (BTRC), Tripoli, Libya.
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Gaisendrees C, Gerfer S, Schröder C, Schlachtenberger G, Walter S, Ivanov B, Eghbalzadeh K, Lühr M, Djordjevic I, Rahmanian P, Mader N, Kuhn-Régnier F, Wahlers T. Benign and malignant cardiac masses: long-term outcomes after surgical resection. Expert Rev Anticancer Ther 2022; 22:1153-1158. [PMID: 35997214 DOI: 10.1080/14737140.2022.2116006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cardiac tumors represent a rare and heterogenous pathologic entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts published for clinical presentation and long-term outcomes after surgical resection. RESEARCH DESIGN Between 2009 and 2021, 183 consecutive patients underwent surgery for tumor excision in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by histology and Immunohistochemical investigations. Kaplan-Meier curves assessed survival, and the Cox, proportional hazards model, was used to identify prognostic factors for overall survival. RESULTS This series included 183 consecutive patients; most (n=169, 92.3%) were diagnosed with benign cardiac masses. The mean age of patients was 60 ± 16 years, and 48% (n=88) were females. The largest group of tumors is represented by myxoma (n = 98; 54%). The most common malignant tumor was sarcomas (n = 5; 2.7%). The mean hospital stay was 11 ± 6.5 days, and all-cause mortality after ten years was 14%. CONCLUSION Surgery represents the gold standard in treating primary cardiac tumors; in benign tumors, it is highly effective and curative, whereas, in malignant tumors, it remains associated with more prolonged survival.
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Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Charlotte Schröder
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Borko Ivanov
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Kaveh Eghbalzadeh
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Maximilian Lühr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Parwis Rahmanian
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
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Velu D, Yendrapalli U, Aziz QUA, Steuber T, Hritani A. A 20-year single community-based tertiary care center’s experience with cardiac myxomas. IJC HEART & VASCULATURE 2022; 41:101069. [PMID: 35707176 PMCID: PMC9189990 DOI: 10.1016/j.ijcha.2022.101069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 12/05/2022]
Abstract
We analyzed 54 cases of cardiac myxoma (n = 40) and non-myxoma (n = 14) diagnosed at a single community-based tertiary care center over 20 years. The data were retrospectively collected for patients between the period January 2000 and September 2020 from the hospital database. We described patient characteristics and clinical features of cardiac myxoma. In patients with diagnosis of cardiac myxoma, the median age was 64 years (range 41–78), with 58% females. Cardiac myxoma patients presented in a variety of ways, as dyspnea (42%), palpitations (20%), and chest pain (15%). Transesophageal echocardiogram was performed in 82.5% of patients. Chest computed tomography (CT) was performed in 32.5%, while cardiac magnetic resonance imaging (CMRI) was performed in 10%. Ischemic evaluation was performed in the majority of patients, primarily having cardiac catheterization. All cardiac myxomas were a single mass and the most common location was the left atrium (n = 34, 85%), followed by the right atrium (n = 6, 15%). 33 (83%) of them were larger than 2 cm. We differentiated cardiac myxoma from non-myxoma mass, which was most commonly a thrombus by histopathology. More patients with cardiac myxoma underwent surgical resection and required hospital and ICU stay than non-myxoma patients. No patients in either group experienced inpatient mortality or a mass recurrence with a median follow-up period of 2 years.
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Marin A, Prasad A, Hechter S, Charles L, Patel P, Durrani M, Imtiaz A, Ganta N, Okere A, Vankeshwaram V, Cheriyath P. A Rare Case of Horseshoe Kidney With Multiple Atrial Myxomas Presenting as Cerebrovascular Accident. Cureus 2022; 14:e26362. [PMID: 35911361 PMCID: PMC9328114 DOI: 10.7759/cureus.26362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Myxomas are benign tumors of mesenchymal origin, containing a few pluripotent cells in the myxomatous stroma. They usually present at 30-40 years of age and are more common in females than males. These tumors mostly arise in the atria and protrude into the atrial lumen. They cause constitutional symptoms like fever and weight loss and obstructive symptoms related to outflow obstruction in the heart. Some tumors are more fragile and cause embolism and may present as stroke. Mostly sporadic but familial cases and myxomas associated with Carney syndrome (CNC) tend to be multiple. Here, we report a case of a 40-year-old female with a stroke due to embolization from multiple myxomas. She had no family history of myxoma and had no skin findings or other tumors associated with CNC. She also had an atrophied horseshoe kidney with renal failure. The association of a horseshoe kidney with myxoma is rarely reported. In an extensive literature search, we could only find only one other case. Atrial myxomas were detected while investigating the cause of stroke. Our patient gradually improved and was advised surgical removal of the myxomas, which is the treatment of choice.
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26
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Azeez H, Abdulrahman ZA, Nguyen T, Tofano M. Left Atrial Myxoma Presenting as Persistent Dizziness. Cureus 2022; 14:e26321. [PMID: 35911261 PMCID: PMC9310553 DOI: 10.7759/cureus.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 12/03/2022] Open
Abstract
Cardiac masses are divided into benign tumors and malignant tumors. The tumor can cause valvular obstruction and embolization phenomenon. To elucidate the etiology of cardiac masses, we rely on the use of echocardiograms in combination with the clinical picture of the patient. We describe an interesting case report of a 71-year-old woman who presented with persistent dizziness for one day. MRI brain showed multiple, small, scattered foci of acute infarction. The patient was treated with aspirin and atorvastatin. Transthoracic echocardiography showed a mass in the left atrium. Afterward, the tumor was removed surgically and histopathology was consistent with atrial myxoma.
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27
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Gaisendrees C, Gerfer S, Schlachtenberger G, Walter SG, Ivanov B, Merkle-Storms J, Mihaylova M, Sabashnikov A, Djordjevic I, Rahmanian P, Mader N, Kuhn-Régnier F, Wahlers T. Cardiac tumors-sex-related characteristics and outcomes after surgical resection. J Surg Oncol 2022; 126:823-829. [PMID: 35665932 DOI: 10.1002/jso.26971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Cardiac tumors represent a rare and heterogeneous pathological entity, with a cumulative incidence of up to 0.02%. Gender was previously reported to influence outcomes after tumor surgery. This study aimed to investigate for gender-related differences in outcomes after cardiac surgery. METHODS Between 2009 and 2021, 95 male and 88 female patients underwent surgery for tumor extirpation in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by (immune-)histopathological analysis. RESULTS There were no significant differences in baseline characteristics and survival. Myxoma was the most common tumor type overall and was more diagnosed in women (n = 36 vs. n = 62, p ≤ 0.001). Sarcoma was the most common malignant tumor type (n = 5). Tumor location at the atrial septum was more likely in women (n = 26 vs. n = 16, p = 0.041), whereas ventricular localization was more common in male patients (n = 20 vs. n = 7, p = 0.001). Minimally invasive tumor extirpation was significantly more often performed in women, and in-hospital stay was shorter in female patients. CONCLUSION The localization and dignity of cardiac tumors differ between genders, not affecting survival. Surgical tumor extirpation remains the gold standard of treatment for cardiac tumors in both genders as it is highly effective and associated with good long-term survivorship.
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Affiliation(s)
- Christopher Gaisendrees
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Sebastian G Walter
- Department of Orthopaedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Julia Merkle-Storms
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Mariya Mihaylova
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Heart Centre, Cologne, Germany
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Newell P, Zogg CK, Kusner J, Hirji S, Kerolos M, Kaneko T. National outcomes following benign cardiac tumor resection: A critical sex-based disparity. J Card Surg 2022; 37:2653-2660. [PMID: 35662249 DOI: 10.1111/jocs.16654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment of benign primary cardiac tumors involves surgical resection, but reported outcomes from multi-institutional or national databases are scarce. This study examines contemporary national outcomes following surgical resection of benign primary atrial and ventricular tumors. METHODS The 2016-2018 Nationwide Readmissions Database was queried for all patients ≥18 years with a primary diagnosis of benign neoplasm of the heart who underwent resection of the atria, ventricles, or atrial/ventricular septum. Primary outcomes were 30-day mortality, readmission, and composite morbidity (defined as stroke, permanent pacemaker implantation, bleeding complication, or acute kidney injury). Multivariable analysis was used to identify independent predictors of worse outcomes. RESULTS A weighted total of 2557 patients met inclusion criteria. Mean age was 61 years, 67.9% were female, and patients had relatively low comorbidity burdens (mean Charlson Comorbidity Index 1.39). The majority of patients underwent excision of the left atrium (71.5%), followed by the intra-atrial septum (26.6%), right atrium (2.9%). There was no difference in 30-day mortality (2.1% vs. 1.3%, p = .550), 30-day readmission (7.0% vs. 9.1%, p = .222), or 30-day composite morbidity (56.8% vs. 53.8%, p = .369) between females and males, respectively. However, on multivariable analysis, female sex was independently associated with increased risk of 30-day mortality (adjusted odds ratio = 2.65, p = .028). Tumor location (atria, ventricles, septum) was not predictive of mortality. CONCLUSION Benign atrial and ventricular tumors are uncommon, but disproportionately impact female patients, with female sex being an independent predictor of 30-day mortality. Root-cause analysis is necessary to determine the ultimate cause of this disparity.
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Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Boston, Massachusetts, USA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Boston, Massachusetts, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan Kusner
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mariam Kerolos
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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29
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A unique and atypical presentation of heart failure secondary to incidental left atrial myxoma in a patient post gynecological surgery. J Cardiol Cases 2022; 25:289-291. [DOI: 10.1016/j.jccase.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022] Open
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30
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Islam AKMM. Cardiac myxomas: A narrative review. World J Cardiol 2022; 14:206-219. [PMID: 35582466 PMCID: PMC9048271 DOI: 10.4330/wjc.v14.i4.206] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka 1207, Bangladesh
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31
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Salem M, Hillmer J, Friedrich C, Panholzer B, Saad M, Salem M, Frank D, Ernst M, Maetzler W, Puehler T, Lutter G, Schoeneich F, Haneya A, Cremer J, Schoettler J. Cardiac Myxomas Resembling Malignant Neoplasia: Incidentally Diagnosed vs. Cerebral Embolized Myxomas. Cancers (Basel) 2022; 14:cancers14051111. [PMID: 35267419 PMCID: PMC8909683 DOI: 10.3390/cancers14051111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cardiac myxomas (CM) are the most common primary cardiac tumors in adults. They are usually benign; however, malignant changes are known to occur but are extremely rare. Embolization is a common complication of cardiac myxomas and can cause neurological deficits before their surgical removal. The current study analyzed the outcomes after operative myxoma excision in patients, with and without cerebral embolic events prior to excision. Methods: All 66 consecutive patients who underwent a surgical excision of CM between 2005 and 2019 at our department were analyzed retrospectively. Patients with (n = 14) and without (n = 52) preoperative strokes caused by cerebral tumor embolization were compared. Results: The mean age was 58.4 ± 12.7 years in the stroke group (SG) and 62.8 ± 11.7 years in the non-stroke group (N-SG) (p = 0.226). Gender (35.7% vs. 61.5% female; p = 0.084) did not differ significantly, and comorbidities were comparable in both groups. The left hemisphere in the territory of the middle cerebral artery was affected by preoperative cerebral infarction most commonly (28.6%). The time from diagnosis to cardiac surgery procedure was 7 (3−24) days in the SG and 23 (5−55) days in the N-SG (p = 0.120). Cardiac myxomas were localized in the left atrium in both groups more frequently (SG: 92.9% vs. N-SG: 78.8%; p = 0.436). In the SG, 57.1% of CM had a non-solid surface, were localized in the left heart, and had a pedunculated attachment away from the fossa ovalis. In the N-SG, 92.3% of CM did not meet all these criteria (p < 0.001). The maximal diameters of CM were comparable (SG: 3.4 ± 1.5 cm vs. N-SG: 3.8 ± 2.1 cm; p = 0.538). The operation times (192.5 (139.3−244.5) min vs. 215.5 (184.5−273.3) min; p = 0.046) and the cross-clamp times (54.5 (33.3−86.5) min vs. 78.5 (55−106.8) min; p = 0.035) were significantly shorter in the SG. Only in the N-SG were reconstructions of the endocardium with bovine pericardium required after resection (51.9% vs 0%; p < 0.001). In the N-SG, CM were explored via the right atrium more often (57.7% vs. 14.3%; p = 0.007). Patients in the N-SG required significantly shorter ICU care after surgery (p = 0.020). Other postoperative courses did not differ significantly. After tumor removal, 1.9% of the N-SG suffered their first stroke and 14.3% of the SG had a cerebral re-infarction (p = 0.111). The 30-day mortality rates were 1.9% in the N-SG and 7.1% in the SG (p = 0.382). In one case in the N-SG, a tumor recurrence was diagnosed. The Kaplan−Meiercurves showed a significantly better long-term prognosis for patients in the N-SG (p = 0.043). Conclusions: After the surgical removal of CM, the outcome is compromised if preoperative cerebral embolization occurs. Surgical treatment is therefore indicated as soon as possible, especially when CM have a non-solid surface, are localized in the left heart, and have a pedunculated attachment away from the fossa ovalis.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- Correspondence: ; Tel.: +49-(0431)-500-67089; Fax: +49-(0431)-500-22004
| | - Jonas Hillmer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Christine Friedrich
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Mohammed Saad
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
| | - Derk Frank
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Markus Ernst
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Walter Maetzler
- Department of Neurology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
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Henmi S, Salica A, Scaffa R, D’Aleo S, Wolf LG, De Paulis R. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac182. [PMID: 35592454 PMCID: PMC9113441 DOI: 10.1093/jscr/rjac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac myxoma is the most common primary benign cardiac tumor in adults and right atrial myxoma is a rare observation. We report a case of a 56-year-old woman who presented with dyspnea and diagnosed with a right atrial myxoma. Urgent operation through a right mini thoracotomy was done and myxoma was completely excised. Traditionally, median sternotomy with cardiopulmonary bypass is used for excision of cardiac myxoma. Excision through a mini thoracotomy for patients with right atrial myxoma appear to be safe, feasible and efficacious.
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Affiliation(s)
- Soichiro Henmi
- Correspondence address. Cardiac Surgery Department, European Hospital, Via Portuense 700, Roma 00149, Italy. Tel: +1-240-797-9787; E-mail:
| | - Andrea Salica
- Cardiac Surgery Department, European Hospital, Rome, Italy
- Unicamillus University, Roma, Italy
| | - Raffaele Scaffa
- Cardiac Surgery Department, European Hospital, Rome, Italy
- Unicamillus University, Roma, Italy
| | - Salvatore D’Aleo
- Cardiac Surgery Department, European Hospital, Rome, Italy
- Unicamillus University, Roma, Italy
| | - Lorenzo Guerrieri Wolf
- Cardiac Surgery Department, European Hospital, Rome, Italy
- Unicamillus University, Roma, Italy
| | - Ruggero De Paulis
- Cardiac Surgery Department, European Hospital, Rome, Italy
- Unicamillus University, Roma, Italy
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33
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Baba A, Hisata Y, Odate T, Yamada T. A giant left atrial myxoma causing left-sided heart failure. SAGE Open Med Case Rep 2022; 10:2050313X221105829. [PMID: 35769831 PMCID: PMC9234930 DOI: 10.1177/2050313x221105829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022] Open
Abstract
This report presents a case study on giant left atrial myxoma. Transthoracic
echocardiography showed a giant mass in the left atrium of a 53-year-old female patient
causing functional mitral stenosis. Tumor resection was performed, and the pathological
diagnosis confirmed the atrial myxoma. Postoperative echocardiography showed no evidence
of any remaining mass and mitral stenosis.
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Affiliation(s)
- Akiko Baba
- Division of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Yoichi Hisata
- Division of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Tomohiro Odate
- Division of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Takafumi Yamada
- Division of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Japan
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34
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Nocco S, Parato V, Alunni G, Becherini F, Conti S, Cucchini U, Di Giannuario G, Di Nora C, Fabiani D, La Carrubba S, Leonetti S, Montericcio V, Tota A, Petrella L. Imaging of cardiac masses: An updated overview. J Cardiovasc Echogr 2022; 32:65-75. [PMID: 36249434 PMCID: PMC9558634 DOI: 10.4103/jcecho.jcecho_18_22] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/04/2022] Open
Abstract
Studying cardiac masses is one of the most challenging tasks for cardiac imagers. The aim of this review article is to focus on the modern imaging of cardiac masses proceeding through the most frequent ones. Cardiac benign masses such as myxoma, cardiac papillary fibroelastoma, rhabdomyoma, lipoma, and hemangioma are browsed considering the usefulness of most common cardiovascular imaging tools, such as ultrasound techniques, cardiac computed tomography, cardiac magnetic resonance, and in the diagnostic process. In the same way, the most frequent malignant cardiac masses, such as angiosarcoma and metastases, are highlighted. Then, the article browses through nontumoral masses such as cysts, mitral caseous degenerative formations, thrombi, and vegetations, highlighting the differential diagnosis between them. In addition, the article helps in recognizing anatomic normal variants that should not be misdiagnosed as pathological entities.
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35
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Eftekharzadeh P, Ahmed S. Acute Coronary Syndrome or Right Atrial Cardiac Myxoma? An Atypical Presentation. Cureus 2021; 13:e19116. [PMID: 34858757 PMCID: PMC8614161 DOI: 10.7759/cureus.19116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/28/2022] Open
Abstract
The size and location of cardiac tumors determine how patients present with signs of heart failure due to diminished cardiac output within the circulatory system. Poor cardiac output presents with signs of heart failure, which include pulmonary edema, lower extremity edema, jugular venous distention, dyspnea, orthopnea and can be insidious in onset. Vital signs on presentation can often be abnormal and patients may present hemodynamically unstable. We present a case of a female who presented to the emergency room after experiencing a sudden onset of substernal, pressure-like chest pain while sleeping. Vital signs on presentation were stable with no evidence of heart failure symptoms as listed above. Cardiac catheterization showed patent coronary arteries but was found to have a 5.8 x 4.7 x 3.5 cm hypervascular cardiac myxoma located in the right atrium. Instead of a typical heart failure presentation, as any space-occupying mass would decrease the effective cardiac output, the patient presented with angina. During the procedure, the mass was noted to be perfused by the left circumflex artery, creating coronary steal phenomenon, shifting blood away from the coronary arteries and into the mass, causing ischemic anginal pain. The patient ultimately underwent surgical excision of the lesion and her anginal symptoms resolved.
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36
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Wu HY, Shou XL, Cao YW. An Unusual Cause of Complete Atrioventricular Block in a Patient With Pedal Swelling. JAMA Intern Med 2021; 181:1650-1651. [PMID: 34661619 DOI: 10.1001/jamainternmed.2021.5968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, People's Republic of China
| | - Xi-Ling Shou
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, People's Republic of China
| | - Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, People's Republic of China
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37
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Leef G, Davis K, Wu KC, Mukherjee M, Madrazo JA. Right Atrial Epidermoid Cyst: An Unusual Mass Discovered in the Workup for Arrhythmia in Pregnancy. CASE 2021; 5:408-411. [PMID: 34993373 PMCID: PMC8713004 DOI: 10.1016/j.case.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiac heterotopia (noncardiac tissue in the heart) is a rare condition. It is thought to be related to disrupted cell migration during development. Cardiac heterotopia can give rises to masses that present with symptoms decades later.
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Affiliation(s)
| | | | | | | | - Jose A. Madrazo
- Correspondence: Jose A. Madrazo, MD, 1800 Orleans Street, Baltimore, Maryland 21287
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38
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Okan T, Babliak O, Agarwal K, Kuzyk Y, Lanka SP, Iskander B, Sharma S, Tadepalli S, Jaiswal R, Hussain A, Rashid MY, Chakinala RC. Asymptomatic Left Atrial Myxoma Treated With Minimally Invasive Surgical Approach. Cureus 2021; 13:e18432. [PMID: 34737901 PMCID: PMC8559889 DOI: 10.7759/cureus.18432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Myxomas, being the most common primary benign tumor among all cardiac tumors, occur rarely with a very low incidence rate. Myxomas can cause various clinical manifestations or can be diagnosed incidentally. Some patients with cardiac myxomas are completely asymptomatic. Cardiac myxomas cause life-threatening complications, thus early diagnosis is imperative. We are reporting a case of atrial myxoma in a 38-year-old female without any significant past medical history, who came to our clinic for cardiology evaluation prior to plastic surgery. The elliptical mobile mass, located in the left atrium with its attachment to the interatrial septum, was diagnosed by transthoracic echocardiography. The patient was referred for surgery and a minimally invasive surgical approach was chosen. A histological report confirmed the diagnosis of myxoma. The patient recovered well. Three years of follow-up did not reveal any signs of recurrence of the tumor. We are also analyzing 20 previously published cases of asymptomatic myxomas and myxomas treated with a minimally invasive surgical approach, reported in the PubMed database for the last 20 years (2001-2021) in the adult patient population (age 19 and over). The aim of this study is to highlight the asymptomatic presentation of cardiac myxomas and to underline the advantages of a minimally invasive surgical approach. In summary, asymptomatic cardiac myxomas are rare incidental findings. Attention to subtle symptoms during a physical exam and scrupulous history-taking can provide a clue to this diagnosis. Early diagnosis of cardiac myxomas is crucial to prevent life-threatening complications. Minimally invasive surgery is a promising alternative approach to standard open-heart surgery for treating cardiac myxomas, providing faster recovery and higher patient satisfaction with surgical care.
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Affiliation(s)
- Tetyana Okan
- Department of Diagnostic Imaging, The Metropolitan Andrey Sheptytsky Hospital, Lviv, UKR
| | - Oleksandr Babliak
- Department of Cardiac Surgery, Cardiac Surgery Center "Dobrobut", Kyiv, UKR
| | - Kriti Agarwal
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Yulia Kuzyk
- Department of Pathological Anatomy and Forensic Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Beshoy Iskander
- Department of Internal Medicine, Bon Secours Mercy Health- St. Elizabeth Youngstown Hospital (NEOMED), Youngstown, USA
| | - Sanjeev Sharma
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA
| | - Satish Tadepalli
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Richa Jaiswal
- Department of Pathology, Medical University of South Carolina, Charleston, USA
| | - Akbar Hussain
- Department of Internal Medicine, Keystone Health System, Chambersburg, USA
| | - Mohammed Y Rashid
- Department of General Surgery, University of Illinois -MGH, Chicago, USA
| | - Raja Chandra Chakinala
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA.,Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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39
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Olsthoorn JR, Daemen JHT, de Loos ER, Ter Woorst JF, van Straten AHM, Maessen JG, Sardari Nia P, Heuts S. Right Anterolateral Thoracotomy Versus Sternotomy for Resection of Benign Atrial Masses: A Systematic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:426-433. [PMID: 34338071 DOI: 10.1177/15569845211032230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Primary benign cardiac tumors are rare disease entity that predominantly originate from the atria. Benign masses can induce heart failure, arrhythmia, or thromboembolic events. Therefore, surgical excision is often indicated. Current guidelines on the preferred approaches for resection (i.e., median sternotomy [MST] or right anterolateral thoracotomy [RAT]) are lacking. The aim of the current meta-analysis was to evaluate all studies comparing RAT to MST for excision of benign atrial masses in terms of safety, efficacy, and complications. METHODS The PubMed and EMBASE databases were searched through 9 June 2020. Data regarding mortality, complications, recurrence, ICU stay, and length of hospital stay were extracted and submitted to meta-analysis using random effects modelling. Heterogeneity was assessed by the I 2 test. RESULTS Four retrospective observational studies were included, including 196 patients (RAT n = 97, MST n = 99). Mortality was 0% in both groups. Recurrence was <1% in the RAT group and 0% in the MST group. Complication rate tended to be lower in favor of the RAT group. Furthermore, RAT was associated with lower length of ICU stay (-17.7 hr, P = 0.01) and hospital stay (-4.0 days, P < 0.001). No significant differences in cardiopulmonary bypass (P = 0.09) and cross-clamp times (P = 0.15) were observed. CONCLUSIONS The RAT approach is as safe and effective as MST for the excision of benign atrial masses. Moreover, RAT is associated with a reduced complication rate and a reduced duration of hospitalization and could be considered as the preferred approach in anatomically suitable patients.
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Affiliation(s)
- Jules R Olsthoorn
- 3168 Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, The Netherlands
| | - Jean H T Daemen
- 3802 Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- 3802 Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Joost F Ter Woorst
- 3168 Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, The Netherlands
| | - Albert H M van Straten
- 3168 Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, The Netherlands
| | - Jos G Maessen
- 118066199236 Department of Cardiothoracic Surgery, Maastricht University Medical Center, The Netherlands
| | - Peyman Sardari Nia
- 118066199236 Department of Cardiothoracic Surgery, Maastricht University Medical Center, The Netherlands
| | - Samuel Heuts
- 118066199236 Department of Cardiothoracic Surgery, Maastricht University Medical Center, The Netherlands
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40
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Belov YV, Nechaenko MA, Fokina OA, Ivanova AG, Kiprensky AY, Gadzhieva SF. [Primary delayed growth of the right and left atrial myxoma]. Khirurgiia (Mosk) 2021:94-97. [PMID: 34270201 DOI: 10.17116/hirurgia202107194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is more than 58-year experience of surgical treatment of patients with intracardiac myxomas at the Petrovsky National Research Center of Surgery. Primary delayed growth of the right and left atrial myxoma after 21 years and 5 months was observed only in 1 (0.36%) patient. Transthoracic echocardiography was used for diagnosis of tumors. Tumors were totally resected including adjacent parts of myocardium or subendocardial tissue with subsequent cautery. In-hospital mortality was absent. There were no recurrent myxomas throughout subsequent 10-year follow-up.
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Affiliation(s)
- Yu V Belov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - M A Nechaenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - O A Fokina
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A G Ivanova
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A Yu Kiprensky
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - S F Gadzhieva
- Petrovsky National Research Center of Surgery, Moscow, Russia
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41
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Bhatia V, Jain C, Ray S, Gupta O, Chatterjee D, Kumar A. Mechanical Thrombectomy in Embolic Cardiac Myxoma: Case Report and Literature Review. Neurol India 2021; 69:707-710. [PMID: 34169873 DOI: 10.4103/0028-3886.319216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Myxomas are the most common cardiac tumors and present clinically with cardiac manifestations, systemic constitutional symptoms, and embolic events. Posterior circulation involvement occurs in approximately 20 percent of cerebral ischemic events.The endovascular technique is an established life-saving therapy for eligible patients upto 24 hours from symptom onset. However, the role of endovascular management in embolic atrial myxoma remains unknown with no international consensus guidelines for the management of stroke in such patient population. Here, we present a case report of an embolic posterior circulation stroke in a young female treated with mechanical thrombectomy at 23 hours from symptom onset. To the best of our knowledge, this is the first thrombectomy case in posterior circulation with embolism from myxoma. Further workup confirmed an atrial myxoma which was resected. We also review the previous cases with mechanical thrombectomy done in such cases.
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Affiliation(s)
- Vikas Bhatia
- Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
| | - Chirag Jain
- Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
| | | | - Ojas Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Ajay Kumar
- Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
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42
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Obagi A, Desai D, Mazahir U, Johnson D, Berger L. Large Right Atrial Myxoma Presenting As Bilateral Pulmonary Embolism. Cureus 2021; 13:e15889. [PMID: 34336411 PMCID: PMC8312776 DOI: 10.7759/cureus.15889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/01/2022] Open
Abstract
Myxoma is a rare benign tumor of the heart. Cardiac myxomas are the most common primary cardiac tumor in adults, commonly found within the left atrium. It can occur at any age and is more common in females than males. This case report aims to identify the clinical symptoms of cardiac myxoma, which can be life-threatening if neglected. Here, we present the case of a 30-year-old female with past smoking history. For the past three to four weeks before this hospitalization, her symptoms worsened including shortness of breath with exertion, dry cough, and pleuritic chest pain. Outpatient treatment with antibiotics and nebulizers did not relieve her symptoms. She went to the emergency room and underwent computed tomography of the chest with contrast showing bilateral lower lobe pulmonary emboli and a large mass in the right atrium. Intravenous unfractionated heparin was initiated. A transthoracic echocardiogram confirmed a 3.76 cm × 4.95 cm mass in the right atrium. The patient underwent surgical resection of the right atrial mass the following day and was discharged four days later in a stable condition. Pathology of the mass confirmed atrial myxoma.
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Affiliation(s)
- Aref Obagi
- Cardiology, Jersey Shore University Medical Center, Neptune, USA
| | - Dhaval Desai
- Cardiovascular Disease, Jersey Shore University Medical Center, Neptune, USA.,Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Usman Mazahir
- Pulmonary and Critical Care Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - David Johnson
- Cardiac Surgery, Jersey Shore University Medical Center, Neptune, USA
| | - Lance Berger
- Cardiology, Jersey Shore University Medical Center, Neptune, USA
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43
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Fan C, Zhang H, Zhuang H, Jiang Z, Tan H, Iroegbu CD, Song L, Liu L. Case Report: Giant Biatrial Myxoma Mimicking Malignant Cardiac Tumor in a Patient With a Hepatic Angiomatous Mass. Front Cardiovasc Med 2021; 8:676807. [PMID: 34124204 PMCID: PMC8192690 DOI: 10.3389/fcvm.2021.676807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/02/2022] Open
Abstract
Cardiac myxomas, primarily originating from the left atrium, are the most prevalent types of benign cardiac tumors; however, biatrial myxomas are extremely rare. Herein, we present a rare case of a 55-year old male with exertional dyspnea and intermittent chest discomfort due to a giant biatrial mass with concomitant atrial fibrillation and hepatic hemangioma. The giant tumor with its peduncle at the interatrial septum involved both atria; however, bulging through the tricuspid valve to the right ventricle during systole. Hence, excision of the giant cardiac tumor (which grossly composed of three parts: stiff, fleshy, and soft) and Cox-Maze IV procedure was performed with the resected specimen measuring 100 × 80 × 40 mm. The patient who was in a stable condition was discharged home on the 12th post-operative day. Thus, given the excellent post-operative results achieved, surgical treatment in large multi-cavitary benign cardiac tumors is feasible and should be considered a potentially curative therapy.
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Affiliation(s)
- Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huanwei Zhuang
- Department of Cardiothoracic Surgery, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Zenan Jiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haoyu Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Long Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liming Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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44
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Siew KSW, Ng KF, Othman N, Lee CY. Unusual cause of heart failure in the young, the intracardiac mass: Diagnostic dilemmas solved by echocardiography. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211011204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumor remains exceedingly rare, accounting for 0.5 cases per million of the population annually. We report a case of cardiac tumor, which was initially misdiagnosed as heart failure secondary to acute coronary syndrome. The diagnosis was revised later after routine echocardiography in the ward. A 39-year-old gentleman who presented to the emergency department with cardiac failure and ischemic changes on the electrocardiogram was initially worked-up for acute coronary syndrome. However, echocardiography was performed later in the ward to evaluate the cardiac ejection fraction, revealing a massive left atrial mass measuring 6 cm × 4 cm. Severe mitral regurgitation was noted through the echocardiogram owing to the mass prolapse into the mitral annulus. The initial presentation of cardiac tumors can be ambiguous. Studies have shown that echocardiography as the noninvasive cardiac imaging approach remains the gold standard of diagnostic tool. Hence, echocardiography should be performed as a routine assessment of cardiac failure. Meanwhile, the incorporation of point of care ultrasound in the available center may assist the physician to diagnose accurately in the emergency department setting by excluding other potential differential diagnoses. Delay in diagnosis and initiation of treatment may result in progression to chronic heart failure and dangerous complication, i.e. hemodynamic sequelae and systemic embolism of the clot. In our experience, we managed to reach an accurate diagnosis, timely referral and appropriate intervention despite the lack of point of care ultrasound.
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Affiliation(s)
| | - Kim Fong Ng
- Department of Cardiology, Hospital Sultanah Aminah, Malaysia
| | - Norliza Othman
- Department of Radiology, Hospital Sultanah Aminah, Malaysia
| | - Chuey Yan Lee
- Department of Cardiology, Hospital Sultanah Aminah, Malaysia
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45
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Wazaren H, Bouhdadi H, El Boussaadani B, Derqaoui S, Hosni A, Idrissa M, Benlafqih C, Rhissassi J, Sayah R, Laaroussi M. An unusual cause of multiple embolic strokes: cardiac myxoma, about a case. J Surg Case Rep 2021; 2021:rjab063. [PMID: 33777351 PMCID: PMC7984845 DOI: 10.1093/jscr/rjab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiac myxomas are the most common primary intracardiac tumors, accounting for 50% of all cardiac neoplasms, with an estimated frequency of 0.5/million/inhabitants/year. Presenting symptoms are related to cerebral or peripheral embolism, and/or intracardiac obstruction. Thus, urgent management of myxoma is mandatory due to embolism's risk. Herein, we report the case of an 82-year-old woman with a myxoma of the left atrium, revealed by a multiple ischemic strokes, to raise awareness of this entity.
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Affiliation(s)
- Hicham Wazaren
- Department of Cardiovascular Surgery A of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Hanae Bouhdadi
- Department of Cardiovascular Surgery A of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Badre El Boussaadani
- Department of Cardiology B of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Sabrine Derqaoui
- Department of Pathology of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Abdelmoughit Hosni
- Department of Radiology of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Malick Idrissa
- Cardiovascular Surgery A Department of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Chakib Benlafqih
- Cardiovascular Surgery A Department of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Jaafar Rhissassi
- Cardiovascular Surgery A Department of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Rochde Sayah
- Cardiovascular Surgery A Department of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
| | - Mohammed Laaroussi
- Cardiovascular Surgery A Department of Ibn Sina University Hospital Center, Mohammed V University of Rabat, Rabat City, Morocco
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46
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Wang L, Chen H, Tian X, Lai J, Liu Y, Zeng X, Zhang F. Vision Loss, Multiple Cerebral Infarction, Ischemia of Extremities: Systemic Vasculitis or Cardiac Myxoma? RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2020; 1:53-55. [PMID: 36465075 PMCID: PMC9524764 DOI: 10.2478/rir-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 06/17/2023]
Affiliation(s)
- Li Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hua Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, The Ministry of Education Key Laboratory, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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47
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Tang Y, Li J, Zhao F, Chen T. Total thoracoscopic surgery for biatrial cardiac myxoma: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1608. [PMID: 33437807 PMCID: PMC7791203 DOI: 10.21037/atm-20-6993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myxoma is the most common type of benign cardiac tumor in adults. Myxoma can occur anywhere in the heart. The left atrium is the most frequent site of origin, specifically located on the left atrium side of the fossa oval in the atrial septum, followed by the right atrium, the right ventricle and left ventricle. But biatrial myxoma is extremely rare. Thoracoscopic resection of myxoma has become more common, but there are few reports on thoracoscopic surgery for biatrial myxoma. We present a case of a 72-year-old woman with biatrial myxoma, who presented with intermittent dyspnea for one week. Echocardiography revealed a medium echo in both the left and right atrium and was connected via the atrial septum. Computed tomography revealed a hypointense mass in both atria. Thoracoscopic resection successfully removed the tumors, and histological examination confirmed the diagnosis. Also, the patient was discharged six days after surgery. There was no evidence of tumor recurrence during the one-year follow-up period. Biatrial myxoma is rare. Surgical resection is the primary method for myxoma. Compared with the traditional medium thoracotomy, thoracoscopic surgery for myxoma has the following advantages: less trauma, keeping the integrity of the sternum, less bleeding, faster postoperative recovery, etc. Total thoracoscopic surgery for biatrial myxomas is effective and safe.
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Affiliation(s)
- Yipeng Tang
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Jinghui Li
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Feng Zhao
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
| | - Tongyun Chen
- Tianjin Chest Hospital, Tianjin University, Tianjin, China
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Eseonu OI, Thomas R. Intra-articular Myxoma Arising from the Scapholunate Ligament: A Rare Cause of Dorsal Wrist Swelling. J Hand Microsurg 2020; 12:197-200. [DOI: 10.1055/s-0038-1675889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AbstractThe differential diagnosis of a dorsal wrist swelling includes ganglion, lipoma, cutaneous tumors, and benign peripheral nerve sheath tumors, with ganglions being the most common. We present the case of a myxoma arising from the dorsal scapholunate ligament mimicking a dorsal wrist ganglion. Volar wrist joint myxomas have been previously reported, but this is the first report of a myxoma arising from the dorsal side of the wrist joint.
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Affiliation(s)
| | - Roshin Thomas
- Dumfries and Galloway Royal Infirmary, Cargenbridge, Scotland, United Kingdom
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Moscarelli M, Rahouma M, Nasso G, di Bari N, Speziale G, Bartolomucci F, Pepe M, Fattouch K, Lau C, Gaudino M. Minimally invasive approaches to primary cardiac tumors: A systematic review and meta-analysis. J Card Surg 2020; 36:483-492. [PMID: 33259109 DOI: 10.1111/jocs.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. METHODS A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intraoperative and postoperative outcomes; tumor size was also considered. RESULTS There were no significant between-group differences in terms of late mortality (incidence rate ratio [IRR]: MI vs. MS, 0.98 [95% confidence interval [CI]: 0.25-3.82], p = .98). Few relapses (IRR: 1.13; CI: 0.26-4.88; p = .87) and redo surgery (IRR: 1.92; 95% CI: 0.39-9.53; p = .42) were observed in both groups; MI approach resulted in prolonged operation time but that did not influence the clinical outcomes. Tumor size did not significantly differ between groups. CONCLUSION Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Mohamed Rahouma
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Martino Pepe
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Christopher Lau
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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Hosain N, Quaium Chowdhury MA, Maruf MF, Chowdhury MR, Barua S, Rahman M. Surgical Treatment of Atrial Myxomas: Outstanding Outcome of a Treacherous Tumor. CJC Open 2020; 3:354-360. [PMID: 33778452 PMCID: PMC7985015 DOI: 10.1016/j.cjco.2020.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background Primary cardiac tumors are quite rare and mostly benign in nature. Most of the benign heart tumors are myxomas. These might present with a wide range of symptoms from being completely asymptomatic to having life-threatening complications like stroke, heart failure, or even sudden death. This study summarizes our 6-year clinical experience with surgical resection of cardiac tumors at Chittagong Medical College and Hospital, Chattogram, Bangladesh. Methods Twenty patients who underwent surgical excision of primary intracardiac myxoma between February 2014 and February 2020 were included in the study. Seventeen (85%) of them were female and 3 (15%) were male. Mean age was 43.4 ± 14.1 years. The tumors were located in the left atrium in 19 patients and in 1 patient it was in the right atrium. The most common attachment site was the interatrial septum. Most of the patients presented with dyspnea. Preoperative diagnosis was established using transthoracic echocardiography with colour Doppler. Surgery for all patients was via median sternotomy. Results All 20 patients survived the surgery. Mean tumor dimension was 4.6 ± 3.5 cm in the longest diameter. Solid tumors were detected in 13 patients (65%) whereas papillary myxomas were found in 7 patients (35%). On follow-up of these 20 patients, there was no perioperative death. One patient presented with recurrence 28 months after the surgery. Conclusions Although cardiac myxomas carry the risk of serious systemic and cardiac symptoms, prompt surgical excision gives excellent outcome.
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Affiliation(s)
- Nazmul Hosain
- Department of Cardiac Surgery, Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | - Mohammad Fazle Maruf
- Department of Cardiac Surgery, Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | - Subir Barua
- Department of Cardiac Surgery, Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Mamunur Rahman
- Department of Anesthesia, Marine City Medical College and Hospital, Chattogram, Bangladesh
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