Right atrial myxoma with a large tumor embolus in the left pulmonary artery

Cardiac myxomas: A single-center case series of 145 patients over a 32-year period study

Background

Myxomas are the most common primary cardiac tumors that develop mostly at the atrial chambers of the heart and represent 0,25% of all cardiac diseases.

Methods

This is a retrospective study aiming to analyze epidemiological and intraoperative data from cardiac myxoma cases in the hospital of the last 32 years. The study population was 145 cardiac surgical patients and was divided into 4 certain 8-year periods. 87,6% of cases had the myxoma located at left atrium and 97,2% of all patients fully recovered. 4,1% of patients relapsed and underwent a redo operation.

Results

Mean CPB time and mean ICU length of stay increased during the 8-year periods (p < 0,001, P < 0,001, P = 0,002 and P = 0,003 respectively). In-hospital length of stay decreased to 5 days in the most recent period (p < 0,001). Cases significantly increased to 54 in the last 8-year period (p = 0,009).

Conclusion

Improvement on cardiac imaging and a better accessibility may drive patients to earlier and safer diagnosis of myxomas preventing any deterioration of their condition. Improvement on postoperative care can also reduce in-hospital length of stay. Surgical excision is the treatment of choice and guaranteed survival at 97,2% of patients.

Left Atrial Myxoma Presenting as Persistent Dizziness

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.

Pulmonary embolism as the initial manifestation of right atrial myxoma: A case report and review of the literature

RATIONALE

Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare.

PATIENT CONCERNS

A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass.

DIAGNOSIS

A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made.

INTERVENTION

Right atrial and pulmonary artery embolectomy.

OUTCOMES

The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful.

LESSONS

RAMs should be considered unlikely reasons for fatal pulmonary embolisms.

Rare Association between Giant Right Ventricular Myxoma and Right Coronary Artery Tumour Blush with Complicating Pulmonary Tumour Embolism

Cardiac myxoma is a benign primary cardiac tumour which can present with nonspecific symptoms of right heart failure, syncope, exertional dyspnea, and pulmonary embolism. We describe a case of a right ventricular myxoma complicated with bilateral pulmonary embolism, with an incidental right coronary artery fistula but otherwise normal coronary anatomy on coronary angiogram. This case report emphasizes the importance of performing a transesophageal echo in the setting of pulmonary embolism to search for the origin of thrombus/tumour, and performing a comprehensive assessment is also necessary to rule out coronary artery disease, coronary artery fistula that may also represent a tumour blush.

Surgical management of a giant right atrial myxoma

Cardiac tumours represent around 0.2% of tumours overall, and primary cardiac tumours are even more uncommon. We report the case of a 72-year-old female with a 7 cm × 4 cm right atrial mass which was prolapsing through the tricuspid valve. The mass was resected and histological analysis confirmed a myxoma. This report describes a rare finding of a giant right atrial mxyoma and subsequent surgical management.

Extracardiac manifestations of atrial myxomas

Primary cardiac tumors are extremely rare and constitute only about 5% of all cardiac tumors. Cardiac myxomas are noncancerous primary tumors of the heart and constitute about of 50% of all primary heart tumors. Left-sided atrial myxomas are more common than right-sided atrial myxomas. Atrial myxomas can lead to a triad of complications. The most common symptoms are associated with obstruction due to the size and location of the tumor. The next most common symptoms are associated with pulmonary and systemic embolization. Patients may also present with constitutional symptoms. Diagnosis is made via means of transesophageal echocardiography and magnetic resonance imaging. Early diagnosis and surgical resection remain the treatment of choice to prevent complications. Patients usually have a good prognosis after resection.