Giant left atrial myxoma mimicking severe mitral valve stenosis and severe pulmonary hypertension

A rare cause of severe mitral stenosis and reversible pulmonary hypertension

Myxoma is a rare cause of severe mitral stenosis. We describe a challenging case of severe mitral stenosis and reversible pulmonary hypertension produced by a giant left atrial myxoma. The greatest risk is a diagnostic delay due to focus on discarding a pulmonary etiology of dyspnea. Physical examination and early echocardiographic assessment are the keys to avoid overlooking this uncommon pathology.

Postoperative atrial fibrillation in patients with left atrial myxoma

Introduction

The aim of this study was to determine the factors associated with postoperative atrial fibrillation (AF) in patients with left atrial (LA) myxoma.

Methods

Thirty-six consecutive patients with LA myxoma (10 men, mean age: 49.3 ± 15.7 years), who were operated on between March 2010 and July 2012, were included in this retrospective study. Pre-operative electrocardiograms and echocardiographic examinations of each patient were reviewed.

Results

Postoperative AF developed in 10 patients, whereas there was no evidence of paroxysmal AF after resection of the LA myxoma in the remaining 26 patients. The patients who developed AF postoperatively were significantly older than those who did not develop AF (median: 61.5 vs 46 years; p = 0.009). Among the electrocardiographic parameters, only P-wave dispersion differed significantly between postoperative AF and non-AF patients (median: 57.6 vs 39.8 ms, p = 0.004). Logistic regression analysis revealed P-wave dispersion (OR: 1.11, 95% CI: 1.003–1.224, p = 0.043) and age (OR: 1.13, 95% CI: 1.001–1.278, p = 0.048) as independent predictors of postoperative AF in our cohort of patients.

Conclusions

P-wave dispersion is a simple and useful parameter for the prediction of postoperative AF in patients with LA myxoma.

Massive atrial myxoma: surgical treatment for an incidentaloma causing dyspnoea

A patient presented having a one-week history of recurrent falls and confusion and weight loss over an unspecified period of time. A chest radiograph revealed bilateral pleural effusions and the patient was treated for community acquired pneumonia. His weight loss and suspicion of malignant disease prompted computer tomography to be conducted. This revealed widespread mediastinal and oesophageal adenopathy. An echocardiogram showed a large hyperechoic mobile mass. Coronary angiography showed complete occlusion of the left anterior descending and right coronary arteries. He underwent two-vessel coronary artery bypass grafting and an atriotomy to excise the myxoma. He experienced no operative complications and no neurological deterioration and was discharged home three weeks later in sinus rhythm. Myxomas can duplicate a broad array of cardiorespiratory symptoms and signs and can often escape detection by being picked up as an incidentaloma.