Cardiac myxomas

Right atrial myxoma excision with pulmonary thrombectomy

Myxomas are the most common primary tumors of the heart. Myxomas that are smooth and large usually present with obstructive symptoms whereas the ones that are villous and friable embolize. Due to the risk of mechanical obstruction and embolization, they require immediate surgical intervention. We present a case of a young female with multiple right atrial (RA) myxomas and embolic occlusion of the right pulmonary artery (RPA) managed successfully with surgical excision and pulmonary thrombectomy.

Navigating Cardiac Myxomas: A Compelling Case of a Giant Atrial Myxoma With Embolic Complications

Cardiac myxomas are the most common primary cardiac tumors, predominantly affecting the left atrium and often seen in women aged 30-60. They can present diagnostic and therapeutic challenges, especially in atypical demographics. If left untreated, myxomas can lead to severe morbidity due to embolic events and intracardiac obstruction. Herein, we describe a rare presentation of an exceptionally large left atrial myxoma, emphasizing the clinical, diagnostic, and surgical considerations required to manage such complex cases effectively. A 61-year-old man with a history of poorly controlled hypertension and hyperlipidemia presented with dyspnea, lower extremity edema, and syncope, as an acute manifestation and was found to have a large, mobile mass measuring 9.5 × 4.5 cm in the left atrium, intermittently prolapsing into the mitral valve orifice during diastole on transthoracic echocardiography, with a provisional diagnosis of myxoma. Additionally, a chest computed tomography scan revealed a subsegmental pulmonary embolus, with the left-sided myxoma being the most plausible cause. Given the tumor size and embolic risk, the mass was managed surgically via a median sternotomy approach. Histopathology confirmed a benign cardiac myxoma, characterized by stellate and myxoid cells within a myxomatous stroma. Postoperatively, the patient's symptoms resolved, and a 12-week follow-up echocardiography showed no residual mass. This case underscores the critical importance of considering cardiac myxoma in the differential diagnosis of acute cardiac symptoms, particularly when embolic phenomena are concurrent. The case highlights the necessity for prompt surgical intervention to mitigate the risk of embolic complications and to restore normal hemodynamic function. Despite the benign nature of myxomas, their potential for severe complications necessitates a high index of suspicion and timely intervention.

The potential role of cardiac CT in ischemic stroke: bridging cardiovascular and cerebrovascular health

Ischemic stroke, accounting for approximately 80% of all stroke cases, remains a leading cause of death and disability worldwide. Effective management of ischemic stroke is heavily influenced by its etiology, which can range from large-artery atherosclerosis and cardiac embolism to cerebral small-vessel occlusions and cryptogenic strokes. Cardioembolic stroke, which makes up about 30% of ischemic strokes, often leads to more severe symptoms and worse outcomes, necessitating anticoagulation therapy for prevention. Cryptogenic strokes, comprising over 25% of ischemic strokes, pose significant challenges for treatment and prevention due to their elusive nature. Thorough investigation of cardioembolic sources during the acute phase of stroke is crucial. While transthoracic and transesophageal echocardiography are traditional methods for detecting intracardiac thrombi and patent foramen ovale (PFO), cardiac CT has emerged as a non-invasive, efficient alternative. Cardiac CT can effectively visualize intracardiac thrombi, PFO, valvular abnormalities, tumors, and complex aortic plaques. This review discusses the potential applications of cardiac CT in ischemic stroke, emphasizing its role in identifying stroke etiology, predicting stroke risk, and assessing patient prognosis. The integration of advanced imaging technologies and artificial intelligence further enhances its diagnostic accuracy and clinical utility, promising to improve outcomes and reduce the healthcare burden associated with ischemic stroke.

Finding of a mass on the mitral valve in a patient on chronic dialysis

Myxomas are cardiac neoplasms that are most commonly located in the left atrium, usually arising from the vicinity of the fossa ovalis. However, there have been cases, although very rarely, of valvular myxoma. A cardiac mass found incidentally on echocardiography can present a challenge in particular if asymptomatic or found in an unusual location. We present the case of a 58-year-old male with kidney disease treated with chronic dialysis, referred to the cardiology clinic because of an incidental finding of a mitral valvular mass on routine transthoracic echocardiography. Although this lesion was initially misdiagnosed as native valvular endocarditis with vegetation, a series of clinical and radiological investigations led to the preoperative diagnosis of possible papillary fibroelastoma or calcified thrombotic mass. Given the increased risk of embolization due to the mass being mobile and greater than 1 cm in size, the patient was referred to cardiac surgery. Excision of the mass without mitral valve replacement was performed. Histopathological findings of the mass revealed the existence of a cardiac myxoma. In such cases of a mitral valve mass, multimodality imaging should have of high priority to achieve an accurate diagnosis. Although a definitive diagnosis can only be established after surgical excision of the mass and histopathological confirmation, it is very important to consider a differential diagnosis of mitral valve myxoma in any patient with an unexplained mitral valve mass.

A male patient with atrial myxoma and multiple metastatic intracranial aneurysms: A case report and literature review

Atrial myxoma is the most common primary benign tumor of the heart, with over 75% occurring in the left atrium. The migration of myxoma cells can lead to rare neurological complications such as intracranial aneurysms, embolic strokes, and arteriovenous malformations. The most common neurological manifestations in such patients include seizures, nonspecific headaches, and cerebrovascular events. Herein, we present a rare case of a middle-aged man in his early 50s with metastatic myxomatous multiple fusiform aneurysms, who initially presented with the clinical manifestation of intracerebral hemorrhage. The patient underwent atrial myxoma resection, whereas the intracranial multiple fusiform aneurysms were managed conservatively. Four years later, digital subtraction angiography revealed progressive enlargement of the aneurysm in the A3 segment of the left anterior cerebral artery. We present the pathological report of the atrial myxoma and imaging findings showing the changes in the aneurysms, along with a review and summary of the relevant literature. This report offers new insights into treatment options for cases of atrial myxoma complicated with intracranial multiple aneurysms. This is the first reported case of a male patient in China presenting with intracerebral hemorrhage as the initial manifestation of atrial myxoma combined with multiple fusiform aneurysms.

New Onset Heart Failure due to Left Atrial Myxoma

Left atrial myxomas are rare cardiac tumors typically presenting with constitutional, obstructive, or embolic symptoms, often managed surgically with positive clinical outcomes. We describe a case of an 88-year-old woman presenting status post fall due to exertional dyspnea and progressive lower extremity edema, found to have an elevated HS-troponin, BNP, and a large left atrial mass on echocardiogram consistent with a cardiac myxoma. Given high surgical risk, palliative care was pursued. This case underscores the need to consider left atrial myxomas in new-onset heart failure.

Perioperative Management of Left Atrial Myxoma Causing Mitral Valve Obstruction and Thrombocytopenia: A Case Report

Left atrial myxomas are the most common primary cardiac tumors, often presenting with symptoms related to obstruction, embolization, or systemic effects. Thrombocytopenia is an uncommon but significant complication associated with myxomas, complicating their management. In this case, a 26-year-old male presented with severe dyspnea, palpitations, and blurred vision. Clinical examination revealed a mid-diastolic crescendo murmur, hepatomegaly, and elevated jugular venous pressure. Investigations showed thrombocytopenia, which is very significant in the perioperative management of this case, requiring specific treatment and precautions to be taken. The other factors, such as elevated liver enzymes and significant mitral valve obstruction caused by a left atrial mass, were also noted. Echocardiography and CT imaging confirmed the diagnosis of left atrial myxoma causing mitral valve inflow obstruction and hepatic congestion secondary to right heart failure. A multidisciplinary team managed the patient, and emergency surgery was performed to excise the tumor and repair the mitral and tricuspid valves with intraoperative transesophageal echocardiographic assistance. Postoperative management included monitoring in the intensive care unit, platelet transfusion, and supportive care, leading to a steady recovery. The patient was discharged on day 10 with stable platelet levels and total left atrial mass removal, which improved cardiac function. Histopathology confirmed the diagnosis of cardiac myxoma. This case highlights the diverse clinical manifestations of left atrial myxomas and the need for prompt diagnosis and multidisciplinary management, especially when complicated by thrombocytopenia and hepatic congestion. Surgical excision remains the treatment of choice, with favorable outcomes following complete tumor removal and valve repair.

Using Computed Tomography Coronary Angiography to Differentiate Atypical Cardiac Myxoma From Thrombus

OBJECTIVE

Atypical cardiac myxoma usually presents as an isolated mass attached to the atrial septum on imaging, with no movement and a wider attachment base. It is difficult to distinguish it from cardiac thrombus through conventional echocardiography or computed tomography (CT). The purpose of this study is to evaluate the value of CT coronary angiography imaging features in distinguishing atypical cardiac myxoma from cardiac thrombus.

MATERIALS AND METHODS

This retrospective study included patients with atypical myxoma of the heart confirmed by histopathology (n = 18) and with thrombus disappearance after anticoagulation treatment (n = 23). All patients underwent a third-generation dual-source CT coronary angiography. We compared the clinical features and CT coronary angiography image characteristics of the 2 groups and used maximum-intensity projection and multiplanar reconstruction to show neovascularization of atypical cardiac myxoma.

RESULTS

There are significant differences in the origin, surface, and enhancement patterns between atypical cardiac myxoma and thrombus (P < 0.05, respectively). Specifically, supplied vessels were observed in the atypical cardiac myxoma group, while no neovascularization was detected in the thrombus group (83.33% vs. 0%, P < 0.001).

CONCLUSIONS

Noninvasive CT coronary angiography can help distinguish atypical cardiac myxoma and cardiac thrombus through imaging features, especially by detecting the supplying vessels. However, supplementary examinations such as cardiac magnetic resonance imaging are still needed to identify different cardiac tumors.

Triple trouble: rheumatic heart disease, infective endocarditis, atrial myxoma

A young college-going male presented with worsening dyspnoea and palpitations for 6 months. He was diagnosed with rheumatic heart disease. The patient's echocardiogram showed not only rheumatic affection of the mitral valve with restricted leaflet movements, but there was also a calcified hyperechogenic mass attached to the atrial aspect of the anterior mitral leaflet, which signified a probable calcified thrombus or an organised vegetation; and a heterogenous, low-attenuating mass attached to the interatrial septum characterised as an atrial myxoma. Considering the gravity of the situation, the patient underwent a successful removal of intracardiac masses with a bioprosthetic mitral valve replacement urgently. Although reported, the occurrence of atrial myxoma with rheumatic heart disease is a rare phenomenon. Left atrial thrombus and myxoma can mimic each other and pose a diagnostic challenge even in today's era of multimodality imaging.

Cardioembolic stroke caused by atrial myxoma

A woman in her early 60s presented with multiple transient neurological symptoms over the course of 20 months, including transient loss of power to her right lower limb. Initial workup with CT brain scan, carotid dopplers and ECG revealed no abnormality; however, MRI of the brain suggested recent ischaemic events in separate cortical territories. Subsequent transoesophageal echocardiogram revealed a large mobile mass histologically confirmed to be an atrial myxoma. This case highlights the challenges in diagnosing atrial myxomas and the importance of thorough workup including cardiac imaging for suspected cerebrovascular events. It also underscores the role of brain MRI when clinical suspicion for a cerebrovascular event persists despite a normal CT scan.

Pulmonary Valve Fibroelastoma, Still a Very Rare Cardiac Tumor: Case Report and Literature Review

Background and Clinical Significance: Primary cardiac tumors are among the rarest types of tumor, and until the mid-20th century, they were diagnosed only post-mortem or during other surgical interventions. With the rapid evolution of cardiovascular imaging and the widespread use of echocardiography, the incidence of cardiac fibroelastoma has increased, though it remains one of the rarest primary cardiac tumors. Papillary fibroelastoma is a benign primary cardiac tumor that develops from endocardial tissue, is usually solitary, and can have multiple locations, with the pulmonary valve being one of the rarest sites. The symptoms and complications depend on the tumor's location, ranging from asymptomatic patients to cerebral ischemic embolism or pulmonary embolism. We analyzed the electronic databases PubMed, Web of Science, and Cochrane and conducted a systematic review of pulmonary valve papillary fibroelastoma (PVPF). Additionally, we included a case from the Adult and Pediatric Cardiovascular Surgery Clinic in Targu Mures. Case Presentation: We present the case of a 58-year-old patient who complained of exertional dyspnea. A transthoracic echocardiography (TTE) revealed a tumor mass attached to the pulmonary valve and coronary angiography identified severe coronary lesions. Following discussions within the Heart Team, surgical myocardial revascularization and tumor excision were decided upon due to the thromboembolic risk. Histopathological examination confirmed the diagnosis of papillary fibroelastoma. The postoperative course was uneventful, with an improvement in dyspnea. The mean age of the patients was 60 years, with half being men (n = 26, 50%). Regarding symptoms, 34% (n = 18) of cases were incidentally identified, while over 30% (n = 17) presented with dyspnea. Pulmonary embolism (PE) was reported in only two patients, and the most common associated comorbidities included high blood pressure (HBP) in 33% (n = 16) and dyslipidemia in 18%. Tumor size ranged from 0.7 cm to 3 cm with the initial benign cardiac tumor; its occurrence in the pulmonary valve remains exceedingly rare. Due to its frequent overlap with other cardiac pathologies, the clinical presentation is often a nonspecific diagnosis or suspicion of a tumor predominantly established via transthoracic echocardiography in 62% of patients. From a surgical perspective, 63% (n = 33) underwent tumor resection with valve sparing, 25% (n = 12) required pulmonary valve repair, and three patients necessitated pulmonary valve replacement. Conclusions: Although the incidence of papillary fibroelastoma is increasing, making it the most common, there is a need to highlight the indispensable role of echocardiography in diagnosis. Although papillary fibroelastoma is benign, surgical intervention is recommended, particularly in symptomatic patients, or if the tumor exceeds 1 cm in size, exhibits increased mobility, or is present alongside other cardiac surgical procedures.

Giant Right Atrial Myxoma: Multimodality Imaging and Management

A 35-year-old man presented to the emergency department with reports of chest pain, progressive shortness of breath, and pedal edema. He had a history of multiple hospital admissions without improvement. Multimodality imaging revealed a suspected giant right atrial myxoma. The patient underwent successful excision of the mass, and his symptoms improved postoperatively. Histopathologic examination of the mass confirmed the diagnosis of atrial myxoma.

Left Atrial Myxoma Presenting With Non-ST Segment Elevation Myocardial Infarction

Cardiac myxoma is a benign cardiac tumor. A rare phenomenon associated with cardiac tumors is the embolization of the myxomatous material into the coronary arteries, leading to myocardial infarction. This typically requires surgical excision of the tumor to prevent recurrence. Early diagnosis with the help of both transthoracic and transesophageal echocardiography is vital in managing these patients. Here, we present a case of a 49-year-old male patient who initially presented with chest pain and non-ST segment elevation myocardial infarction (NSTEMI) and subsequently newly diagnosed cardiomyopathy. Upon further cardiac evaluation, he was found to have a large left atrial myxoma with non-obstructive coronary artery disease. It was suspected that the etiology for NSTEMI and subsequent newly diagnosed cardiomyopathy was due to myxomatous embolization into the coronary arteries; ischemic cardiomyopathy was excluded by definition. The patient subsequently underwent successful surgical excision of the left atrial myxoma.

Progressive Acute Lower Extremity Ischemia Resulting From Cardiac Myxoma Embolization: A Case Report

Cardiac myxomas are the most common primary benign tumors of the heart. The occlusion of peripheral arteries and complete obstruction of the abdominal aorta by a tumor embolus presents with distinct clinical manifestations. Herein, we present the case of a 38-year-old male with acute paresthesia, muscle weakness, erythematous, and violaceous changes in skin color localized to the dorsum of the left forefoot initially treated as cutaneous vasculitis. Further studies revealed the total occlusion of the terminal abdominal aorta by a saddle embolus from a cardiac myxoma. A multidisciplinary team consisting of cardiothoracic and vascular surgeons were involved in treating the patient, which resulted in full resolution of the case. This paper details the progression of acute bilateral limb ischemia to chronic limb threatening ischemia resulting from the total occlusion of the terminal abdominal aorta by a saddle embolus.

Percutaneous Excision of Left Atrial Myxoma Using Transcatheter Electrosurgery

Left atrial myxoma is the most prevalent primary cardiac tumor, known for its high risk of systemic embolization. Although surgical excision remains the standard treatment, options are limited for high-risk patients. This case report introduces a novel approach using transcatheter electrosurgery to address a left atrial myxoma via a transseptal approach in a patient ineligible for conventional surgery due to the heightened risk of intracranial hemorrhage associated with cerebral amyloid angiopathy. Despite encountering technical challenges, this innovative procedure represents a pioneering application of transcatheter surgery for managing left heart tumors.

Could Pulsed Wave Tissue Doppler Imaging Solve the Diagnostic Dilemma of Right Atrial Masses and Pseudomasses? A Case Series and Literature Review

Even if rarely detected, right atrial (RA) masses represent a diagnostic challenge due to their heterogeneous presentation. Para-physiological RA structures, such as a prominent Eustachian valve, Chiari's network, and lipomatous atrial hypertrophy, may easily be misinterpreted as pathological RA masses, including thrombi, myxomas, and vegetations. Each pathological mass should always be correlated with adequate clinical, anamnestic, and laboratory data. However, the differential diagnosis between pathological RA masses may be challenging due to common constitutional symptoms, as in the case of vegetations and myxoma, which present with fever and analogous complications such as systemic embolism. The implementation of transthoracic echocardiography (TTE) with pulsed wave (PW) tissue Doppler imaging (TDI) may improve the visualization and differentiation of intracardiac masses through different color coding of the pathological structure compared to surrounding tissue. More remarkably, PW-TDI can provide a detailed assessment of the specific pattern of motion of each intracardiac mass, with important clinical implications. Specifically, a TDI-derived pattern of incoherent motion is typical of right-sided thrombi, myxomas, and vegetations, whereas right-sided pseudomasses are generally associated with a TDI pattern of concordant motion synchronous with the cardiac cycle. An increased TDI-derived mass peak antegrade velocity may represent an innovative marker of the embolic potential of mobile right-sided pathological masses. During the last two decades, only a few authors have used TTE implemented with PW-TDI for the characterization of intra-cardiac masses' morphology and mobility. Herein, we report two clinical cases of totally different right-sided cardiac masses diagnosed using a multimodality imaging approach, including PW-TDI, followed at our institution. The prevalence and physiopathological characteristics of the most relevant RA masses and pseudomasses encountered in clinical practice are described in the present narrative review. In addition, we will discuss the principal clinical applications of PW-TDI and its potential value in improving the differential diagnosis of pathological and para-physiological right-sided cardiac masses.

Neurological complications of left atrial myxoma: a case report on stroke with left atrial myxoma and postoperative brain metastasis and cerebral aneurysm

Atrial myxoma is a rare benign tumor that can cause a variety of complications, including cerebral infarction. We present a case of a 52-year-old female patient who developed cerebral infarction caused by an atrial myxoma. The patient underwent successful surgical resection of the tumor, and the infarction was managed accordingly. However, 15-months post-surgery, the patient developed new neurological symptoms. Imaging studies revealed multiple cerebral metastases, consistent with the possibility of seeding of tumor cells. This rare complication emphasizes the importance of long-term monitoring after the resection of atrial myxomas. The occurrence of metastasis in the brain, though rare, should be considered in follow-up care, particularly in patients who have had embolic events related to atrial myxomas. Our case highlights the potential for cerebral myxoma metastasis even after initial successful surgical intervention, underscoring the need for comprehensive follow-up and vigilant monitoring of such patients.

Cardiac Myxomas in Carney Complex: Single Institution Multidecade Experience

BACKGROUND

We present our surgical experience with cardiac myxomas in the setting of Carney complex (CNC).

METHODS

We searched our institutional data explorers to identify patients diagnosed with CNC. We gathered clinical, surgical, and recurrence data from electronic medical records. In total, 38 patients with CNC were documented from 1970 through 2023.

RESULTS

Cardiac myxomas developed in 24 patients (63.1%) in the setting of CNC. The median age of onset for cardiac myxoma occurrence was 39.0 years (interquartile range [IQR], 25.0-56.0 years). Most patients were females (62.5%), and all underwent surgery. A total of 42 myxomas (52.7%) were extracted from the left atrium, 12 (15.0%) from the right ventricle, 11 (13.7%) from the right atrium, and 6 (7.5%) from the left ventricle. Among the 24 myxoma patients, 13 (54.1%) experienced at least 1 myxoma recurrence. The median time for the first myxoma recurrence was 7.5 years (IQR, 3.8-10.0 years). There were 27 recurrences (52.9%) from the same chamber, 11 (29.4%) from different chambers, and the localizations in 9 (17.6%) were undocumented. The freedom from tumor recurrence was 100% (95% CI, 100%-100%), 66.7% (95% CI, 44.7%-99.5%), and 16.7% (95% CI, 4.7%-59.1%) at 1, 5, and 10 years, respectively. The long-term survival was 100% at 10 and 15 years.

CONCLUSIONS

Cardiac myxomas developed in nearly two-thirds of CNC patients (63.1%) in this study, and more than half (54.1%) experienced recurring instances. Consistent monitoring through echocardiograms is essential for detecting asymptomatic first-time occurrences or recurrences. Surgical removal remains the key treatment method for managing cardiac myxomas associated with CNC.

Giant Right Atrial Myxoma Coexisting With Tricuspid Regurgitation, Coronary Artery Disease, and Aortic Stenosis

A 70-year-old man presented to our hospital with chest discomfort and epigastric pain. Echocardiography revealed a giant atrial myxoma in the right atrium with severe tricuspid regurgitation. The aortic valve was calcified, and severe aortic stenosis was observed. Coronary angiography revealed diffuse lesions in the right coronary artery. The myxoma was surgically excised, and the residual septal defect was repaired using autologous pericardium tissue. Tricuspid valve annuloplasty, aortic valve replacement, and coronary artery bypass grafting were then performed. Clinicians should be aware that myxomas can coexist with other cardiac diseases. Careful preoperative evaluation and surgical planning should be performed prior to urgent surgeries for myxomas.

A pair of two atrial myxomas mimic thrombus in left atrial appendage and cause ischemic stroke in a young adult: a case report

Background

Stroke is one of the leading causes of mortality and disability and can be rarely caused by cardiac myxoma.

Case Summary

Here, we report about a 56-year-old man who suffered from a stroke presented with acute dysarthria and left hemiparesis. Magnetic resonance imaging (MRI) of the brain revealed an acute stroke. Atrial fibrillation (AF) was assumed the cause of stroke. Because of contraindication to anticoagulation due to previous cerebral haemorrhage with rivaroxaban the patient was admitted to interventional occlusion of left atrial appendage. Echocardiography revealed two left atrial masses suggestive of atrial myxomas. The patient was transferred to remove the two myxomas operatively with simultaneous resection of left atrial appendage.

Discussion

Atrial myxomas should be considered as a possible differential diagnosis of cardioembolic stroke. They should be managed early to prevent recurrent strokes.

Cardiac Myxoma as a Mimicker of Cerebral Vasculitis: A Case Report

Cardiac myxoma is considered the most common primary cardiac tumor and has been reported to cause different neurological complications through distinctive mechanisms, including pseudovasculitis. Herein, we present and review a case of a young male with a previous history of ischemic stroke who presented with multiple territorial ischemic insults in the presence of a presumed diagnosis of vasculitis. Once further workup was done, he was found to have a left atrial myxoma.

Right atrial cardiac myxoma with malignant transformation to undifferentiated sarcoma: A case report

Generally, sarcomas arising from benign soft tissue are rare. Cardiac myxoma (CM) is a benign tumor, and few reports have described its malignant transformation. Herein, we documented a case of an 89-year-old man with prostate cancer and a 5-year history of a right atrium tumor without Carney complex. The tumor was resected surgically and had a myxomatous or gelatinous appearance. Microscopically, the tumor had two components: a sarcomatous area and myxomatous area. In the myxomatous area, typical myxoma cells were demonstrable and were strongly immunoreactive for immunohistochemistry (IHC) of calretinin. In the sarcomatous area, the epithelioid- to spindle-shaped cells with prominent atypia proliferated densely. The IHC profile of cells in the sarcomatous area was different from that of cells in the myxomatous area; MDM2-positive cells were found only in the sarcomatous area. Especially, the Ki-67 index and number of p53-positive cells in the sarcomatous area were higher than those in the myxomatous area. The transition of the two components was seamless. Thus, we made a diagnosis of CM with malignant transformation corresponding to undifferentiated pleomorphic sarcomas. This case suggests that CM may transform into sarcoma, albeit rarely.

Stroke as the first manifestation of an atrial myxoma. Review of the literature

Cardiac myxoma (CM) is the most common benign tumor of the heart and an important etiology of stroke in young adults. The study aimed to provide the latest literature data on CMs and, in particular, on the association between CM and cardioembolic ischemic stroke. It also discussed a specific instance of atrial myxoma (AM) in a young patient who suffered an ischemic stroke linked with familial cavernomatosis. The case presentation focuses on a 43-year-old woman showed up at the hospital's Emergency Room for transient speech disorders lasting about 15 minutes. The physical examination revealed preserved mental and cognitive status. Cranial magnetic resonance imaging (MRI) showed three areas of microvascular ischemia (frontal, parietal, and left occipital), in addition to multiple cavernomatous lesions. Because these microvascular ischemias were located in different vascular territories, we considered the cause to be embolic and completed the investigation with a transesophageal cardiac ultrasound that revealed a mobile and heterogeneous tumor mass in the left atrium. Histopathological investigation with immunohistochemistry proved the tumor to be a CM. The patient therapy included a multidisciplinary approach, which led to surgical excision of the tumor. The co-existence of cerebral cavernous malformations (CCMs) and AM might thus be coincidental or induced by a common genetic component. More cases are needed to verify or disprove the concept of a shared genetic basis for CCMs and myxoma.

Point-of-care Ultrasound: A Window into the Diagnosis of Atrial Myxoma in Stroke-like Patient

Cardiac myxoma, the most common primary cardiac tumor, is indeed rare, with an estimated incidence of 0.03% in the general population. Despite its rarity, it can lead to severe complications such as intracardiac obstruction, emboli, and constitutional symptoms. Surgical excision of myxomas is associated with excellent outcomes and low rate of recurrence. Herein, we will report a case where the lesion was discovered early by point-of-care ultrasound (POCUS), allowing for the quickest possible prompt intervention. A 45-year-old man presented with a 1-day history of dizziness, right-sided body weakness, and facial asymmetry, which led to a motorbike fall. POCUS performed noted mass-like lesions measuring 7 cm by 6 cm, moving freely in the left atrium and prolapsing through the mitral valve during each cardiac cycle. The lesion appears to originate from the septal rather than the atrial appendage, which gives rise to a higher suspicion toward the left atrial myxoma than the left atrial thrombus. Besides, there are areas of liquefaction seen within the mass. He underwent a sternotomy and excision of the left atrial myxoma within the same hospitalization. Histopathology examination of the excised lesion confirmed the diagnosis of atrial myxoma. Early detection and surgical intervention result in a favorable prognosis. Upon discharge, he was stable, ambulating independently with minimal residual facial asymmetry.

Long-term control of haemorrhagic brain metastases from atrial myxoma after radiotherapy

BACKGROUND

Cardiac myxoma is a rare, benign tumour that commonly originates in the left atrium and may lead to embolic events. Parenchymal brain metastases represent a rare neurological manifestation. While surgical intervention is commonly used, there is limited information on long-term outcomes after radiotherapy treatment. This report describes a case of successful treatment of haemorrhagic brain metastases with radiotherapy and offers a literature review of long-term results after radiotherapy treatment.

CASE REPORT

A 49-year-old woman presented with multiple haemorrhagic brain lesions and a cardiac mass. Surgical removal of the cardiac mass and the symptomatic brain lesion confirmed metastatic cardiac myxoma. Post-surgery, she experienced fatigued and neurocognitive impairment and was closely monitored. However, the metastases progressed. She subsequently received whole-brain radiotherapy, resulting in complete response. Seven years later, she remains in remission, although with enduring neurocognitive impairment.

CONCLUSIONS

Whole-brain radiotherapy can provide long-term control of haemorrhagic brain metastases arising from cardiac myxoma. Radiotherapy dose and treatment volume need careful consideration to reduce toxicity.

[Large intracardiac mass revealed by cerebrovascular accident: a case report]

Intracardiac masses may be revealed by an ischemic cerebrovascular accident (stroke). They are sometimes difficult to differentiate by echocardiography. Determining their nature is a crucial aspect of patient management. We here report the case of a 58-year-old man with untreated hypertension, active smoking, a history of psoriasis, chronic obstructive pulmonary disease (COPD) and a nodule in the left upper lobe suspected to be lung cancer. He was hospitalized for an ischemic stroke which was treated with thrombolysis, resulting in hemorrhagic transformation. Routine echocardiography revealed a large mass in the left atrium suggestive of intra-atrial myxoma. Histological examination of the surgical specimen confirmed the diagnosis. Left atrial myxomas can remain asymptomatic for a long time and may be revealed by systemic embolic complications. Echocardiography guides the diagnosis and anatomopathological examination confirms it. Management should be multidisciplinary.

A rare case of myxoma mimicking pulmonary thromboembolism: a case report

Studies have shown that primary cardiac tumors are exceptionally rare and among them myxomas represents approximately half. Although majority of these benign tumors are located in left atrium, they can also emerge in the right cardiac chambers and also on cardiac valves. In rare instances, they may extend into the great vessels. In this case, we present a teenage girl with a past medical history of successfully cured acute lymphoblastic leukemia, who presented with progressive dyspnea and lower limbs edema. Based on history, laboratory, and echocardiographic evidences, she was initially treated for high-risk thromboembolism but after inefficient response, she underwent surgery, with a large right ventricular outflow tract myxoma being diagnosed.

Left ventricular myxoma with carcinoid heart disease: A case report of a 14-year-old child from Jimma Medical Center of Ethiopia

Understand the importance of considering alternative diagnosis in patients presenting with atypical features, specially when they are not responding to the standard treatment. Understand the importance of considering common presentations of rare cases. Underscoring the critical importance of timely recognition and appropriate management of potentially life-threatening conditions.

10× single-cell sequencing revealed cellular composition heterogeneity in cardiac myxoma with malignant glandular properties

Cardiac myxoma is the most common primary cardiac tumor in adults. The histogenesis and cellular composition of myxoma are still unclear. This study aims to reveal the role of myxoma cell components and their gene expression in tumor development. We obtained single living cells by enzymatic digestion of tissues from 4 cases of surgically resected cardiac myxoma. Of course, there was 1 case of glandular myxoma and 3 cases of nonglandular myxoma. Then, 10× single-cell sequencing was performed. We identified 12 types and 11 types of cell populations in glandular myxoma and nonglandular myxoma, respectively. Heterogeneous epithelial cells are the main components of glandular myxoma. The similarities and differences in T cells in both glandular and nonglandular myxoma were analyzed by KEGG and GO. The most important finding was that there was active communication between T cells and epithelial cells. These results clarify the possible tissue occurrence and heterogeneity of cardiac myxoma and provide a theoretical basis and guidance for clinical diagnosis and treatment.

Pulmonary embolism from right ventricular myxoma in a child with undiagnosed Carney complex

Pediatric pulmonary embolism occurs in 8.6-57 per 100,000 hospitalised children. We report a novel case of bilateral pulmonary emboli in a child presenting with dyspnoea who was found to have large right ventricular myxoma and subsequent diagnosis of Carney complex. After resection of the right ventricular myxoma and bilateral pulmonary embolectomy, she had a full recovery and an excellent outcome.

Two cerebral infarctions caused by thrombus and myxomatous embolus in a patient with cardiac myxoma: A case report

An increasing number of cases of cerebral embolism caused by cardiac myxoma have been reported. However, cerebral infarction caused by different types of emboli obstructing different vascular regions within a short period of time has not been reported. This is the first report to histologically confirm cerebral infarctions independently caused by thrombus and myxomatous embolus in a patient with cardiac myxoma within a period of 23 days. The first cerebral infarction was due to embolization of thrombus to the right middle cerebral artery, whereas the second was due to embolization of tissue from a mucinous tumor to the left middle cerebral artery. Both cerebral infarctions underwent mechanical thrombectomy, but unfortunately, we ultimately failed to save the patient's life. Therefore, further attention should be paid to the surgical resection and treatment of cardiac myxoma.

An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment

Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass' blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.

Acute ST-Elevation Myocardial Infarction in a Young Adult: Rare Presentation of Giant Atrial Myxoma

Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events. We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic. In the reported case, the patient's profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.

Management of left atrial myxoma in pregnant women: a case series

BACKGROUND

Left atrial myxoma during pregnancy is rare. We present three cases in order to aid in the management.

CASE PRESENTATION

Three cases of left atrial myxoma during pregnancy were presented in this article. Three patients all received multidisciplinary team work and acquired good outcomes. The case 1 had no symptoms and delivered before traditional cardiac surgery. The case 2 and case 3 undergone totally endoscopic minimally invasive cardiac surgery during pregnancy. The case 3 maintained pregnancy to term and gave birth to a healthy baby via vaginal delivery. No relapse of the tumor was observed.

CONCLUSIONS

The management of left atrial myxoma during pregnancy ought to be individualized and combined with the gestational age. If the diagnosis was made in the first two trimesters of pregnancy, totally endoscopic minimally invasive cardiac surgery during pregnancy would be an optimal choice. The patients can benefit from the multidisciplinary team work.

Cardiac myxomas: causes, presentations, diagnosis, and management

Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.

Anesthetic management of a patient with incidental left atrial myxoma for proximal femur nailing: A case report

Cardiac myxomas are rare tumors with risks of cardiac outflow obstruction and embolic events. Surgical excision of the tumor at the earliest is the definitive treatment. We report the successful anesthetic management of a 65-year-old female patient with incidental left atrial myxoma for right proximal femur nailing. The patient was asymptomatic with no significant cardiac history. Since fracture reduction cannot be deferred for a prolonged period, the case was taken up under general anesthesia with invasive blood pressure monitoring.

Considerations and anesthetic management of a patient with giant right atrial myxoma: A case report and literature review

BACKGROUND

Myxoma is a common type of primary cardiac tumor. However, there are few researches to illustrate challenge of safely inducing anesthesia in a patient with a giant right atrial myxoma at moderate altitude.

PATIENT CONCERNS AND DIAGNOSES

A 54-year-old female patient lived in a city with an average altitude of 1932 m with scheduled surgical treatment for giant right atrial myxoma, prompting discussions on appropriate anesthesia modalities given her prolonged residence at moderate altitude.

METHODS AND RESULTS

Considering the potential impact of moderate altitude on perioperative management, this study emphasizes the necessity of adequate volume preload therapy and the utility of transthoracic echocardiography or transesophageal echocardiography to prevent hemodynamic compromise. Furthermore, it highlights the unique consideration that, post-tumor removal, hypotension may not necessarily lead to decreased oxygen saturation in these patients.

CONCLUSION

This case underscores the importance of avoiding hypotension, as pre-tumor resection blood pressure maintenance primarily determines blood oxygen concentration. Additionally, it sheds light on the intriguing observation that post-tumor removal hypotension may not result in decreased oxygen saturation. These findings have significant implications for the perioperative care of patients with giant right atrial myxoma at moderate altitudes.

Large Right Atrial Myxoma: A Rare Presentation

We present a case of a 74-year-old female with a large right atrial myxoma who initially presented to her primary care physician with nonspecific constitutional and abdominal symptoms. Her presenting symptoms were initially thought to originate from her gastrointestinal tract, but her workup for a gastrointestinal disorder was nondiagnostic. It was not until this patient developed symptoms of overt right heart failure that a cardiac condition was suspected. Our case highlights the importance of understanding the potential of cardiac myxomas to mimic many diseases, including cardiac, infective, neurologic, immunologic, pulmonary, and malignant diseases. Therefore, clinicians must always maintain a high index of suspicion for cardiac myxomas when evaluating patients with cardiac and non-cardiac-related symptoms that may be due to these tumors.

Left atrial myxoma as a rare cause of stroke

Cerebrovascular events may attribute to the fragmentation of a cardiac tumor. Due to the small number of reported cases of large vascular occlusion-acute ischemic stroke (LVO-AIS) associated with atrial myxoma, current guidelines still follow the principle of intravenous thrombolysis priority, even if LVO-AIS patients are eligible for mechanical thrombectomy, and have not recommended the timing of cardiac surgery or preoperative anticoagulation and antithrombotic therapy. Surgical removal is the definitive therapy for cardiac myxomas, especially for left-sided myxomas. With this case, we aim to demonstrate the main challenges that clinicians may encounter when dealing with patients with AIS secondary to cardiac myxoma: the difficulties with clinical diagnosis, strategies for reperfusion therapy, and therapeutic management of cardiac myxoma.

A Firing Cannon: Bilateral Lower Limb Ischemia as a Manifestation of Cardiac Myxoma

Background  Cardiac myxomas are the most common primary cardiac neoplasms. Case Description  We present a case of a middle-aged lady with cardiac myxoma in her left atrium awaiting semi-elective surgery. During the preoperative period, the patient presented emergently with acute bilateral lower limb ischemia. This lady was fortunate to have these emboli fired towards a tissue with ischemia tolerance capacity. If these emboli had been directed toward the central nervous system, this patient would have experienced devastating complications and even death. Conclusion  This presentation opens the debate on the timing of surgical intervention in myxoma patients.

Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review

Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.

Left Atrial Myxoma and Antiphospholipid Syndrome-A Case Report

Cardiac myxoma (CM) is the most frequent type of primary cardiac neoplasm and is responsible for 58 to 80% of primary cardiac tumors. The antiphospholipid syndrome (APS) occurs most commonly in the systemic lupus erythematosus but it can be also found in other conditions. The coexistence of CM and APS is rarely described in the literature. We report an unusual case of the left atrial myxoma and concomitant APS in a female patient who presented with right-sided hemiplegia. Although rare, we must think about the CM in patients with a newly diagnosed APS and left atrial mass. Nevertheless, we must make a distinction from other possible cardiac structures, especially atrial thrombus. Transthoracic echocardiography is the most frequently used initial imaging modality to detect CM. The aim of this case report was to emphasize that additional imaging modalities and multidisciplinary approach are mandatory in making a proper diagnosis and to choose a further treatment strategy.

Pathological features of primary cardiac myxoid tumour in dogs: a review of 11 cases (2002-2022)

This report documents the pathological features of primary cardiac myxoid tumour (MT) in 11 dogs. Macroscopically, all the tumours were located in the tricuspid valve (TV), its septal leaflet being predominantly affected. Therefore, it appears that the TV is the most common site of occurrence for cardiac MT in dogs. Two gross anatomical types of canine valvular MT were evident. Seven of the 11 tumours were round or oval with a smooth or gently lobulated and glistening surface, while the other four were gelatinous, multilobulated and polypoid, with an irregular surface. Microscopically, in nine cases the tumours had an abundant myxoid matrix within which elongated spindle-shaped cells with no remarkable cytological atypia were sparsely embedded, suggesting a benign character (ie, myxoma). In the other two cases the tumours consisted of variably dense, haphazardly arranged, interlacing streams of anaplastic spindle-shaped or polygonal cells containing many mitotic figures, indicative of a malignant form of myxoma (ie, myxosarcoma). Isolated or clustered collections of myxoma cells (eg, cords, rings, syncytia) characteristic of human atrial myxoma were only rarely evident or lacking in all 11 cases, indicating that rarity or absence of such structural features may be specific to valvular MTs. Immunohistochemical findings were indicative of smooth muscle differentiation of the neoplastic cells. Tumour embolization to the intrapulmonary arteries and/or tumour implantation on the endocardium of the right heart chambers was evident only in the four cases of irregular-surfaced MT.