Left atrial myxoma as the cause of syncope in an adolescent

Abstract

In agreement with classical data from the Institute of Pathology of the Armed Forces (Washington, DC), primary tumors of the heart, benign or malign, are found in 0.001% -0.28% of all of autopsies, and the myxomas represent 50% of the benign tumors of the heart 1 . Clinical experiences at two of the largest Brazilian institutions (InCor-USP and Dante Pazzanese Institute of Cardiology) demonstrate the wide prevalence of the heart myxomas as primary heart tumors. At InCor-USP, in a series of 50 patients treated over a period of 18 years, 84% of the myxomas were of the histological type 2 . At the Dante Pazzanese Institute of Cardiology, the experience was similar. Over a period of 28 years, with a series of 52 patients with heart tumors, 82.7% of the tumors were myxomas 3 . At the Ribeirão Preto Heart Hospital, over a period of 23 years, surgeons at the CECORP -Ribeirão Preto Specialized Heart and Lung Center operated on 7 patients for removal of heart tumors, 6 patients with myxomas and 1 patient with leiomyosarcoma metastasis. Among the 6 patients with heart myxomas, the age varied from 14 to 78 years, 4 were females, and all tumors were located at the left atrium. Although syncope is a symptom thoroughly described, resulting from myxoma left ventricular inflow obstruction, its incidence in the adolescent is rare, creating difficulties for the clinical evaluation of syncope in this age group. A unique case was reported in the literature of syncope as a consequence of left ventricle outflow obstruction, caused by a myxoma localized in this cardiac chamber 4 . A case of ischemic stroke in an 8-year-old female child has been reported in the Brazilian literature 5 . These data justify this case report of syncope in an adolescent caused by the presence of a left atrial heart myxoma that intermittently obstructed the mitral valve. Case ReportA 14-year-old female, resident of São Simão (SP), had a clinical cardiology appointment in April 2000 because of 3 episodes of syncope over the previous 3 months. During this interval of time, she was evaluated by a neurologist, without any diagnostic conclusion about the syncope. She was then directed to the cardiologist due to the presence of palpitations experienced at rest.During the first cardiology consultation, a syncope diagnosis was the main focus of the investigation. The clinical anamnesis revealed palpitations, a heart rate of 130 bpm, and low corporal weight with accentuated loss in the prior 3 months. The heart auscultation, by this time, did not show evidence of a heart murmur. With the clinical hypothesis of hyperthyroidism, thyroid hormone dosages and an electrocardiogram were requested. The hormonal function was normal. The electrocardiogram identified a sinus tachycardia and a possible left atrium enlargement. The diagnostic

Postoperative atrial fibrillation in patients with left atrial myxoma: cardiovascular topic

“…Symptoms depend on the size, form, mobility and location of the tumour. 40 The obstruction, mainly caused by large, pedunculated tumours, can decrease cerebral flow and lead to syncope. Also the risk of embolism is higher for polypoid or multilobular tumours.…”

Arrhythmias are not to blame for all cardiac syncope patients: left atrial myxoma causing syncope in a middle-aged man

“…Her ECG showed atrial fibrillation and echocardiography revealed large right atrial myxoma 9. Nogueira et al 10 cited a case report of a 14-year-old girl with a history of recurrent syncope. Her investigation exhibited left atrial myxoma.…”

Atrial myxoma-related embolism resulting in acute limb ischaemia in a critical care patient

“…[9] Large left atrial tumours impairing intracardiac blood flow can produce variable clinical features, from slowly progressive orthopnoea and paroxysmal nocturnal dyspnoea, to acute pulmonary oedema, syncope or sudden death. [10,11] Sudden death resulting from very small tumours is more likely to be related to embolism to the coronary or cerebral arteries.…”