Left Atrial Myxoma Following Coronary Artery Bypass Grafting with Patient Coronary Arterial Grafts: a Rarity

Patel, Kartik; Rahul, Kumar; Tarsaria, Malkesh; Malhotra, Amber

doi:10.21470/1678-9741-2016-0080

Cited by 3 publications

(5 citation statements)

References 3 publications

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“…Using the previous inframammary incision site for breast augmentation as opposed to making another periareolar skin incision also carries an advantage of cosmetic preservation. The right anterior thoracotomy approach could also be beneficial in patients with left atrial myxoma who had previous coronary artery bypass grafting as the avoidance of sternotomy abates the risk of injuring patent grafts that may be adhered to the sternum [6].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Inframammary Approach to Left Atrial Myxoma Resection

Kang

Bozso

Neufeld

et al. 2020

SN Compr. Clin. Med.

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Minimally invasive techniques for myxoma resection are rapidly becoming standard of care for such lesions. Inframammary incisions are commonly used in breast reconstruction. The use of this previous incision for myxoma resection is safe and serves as a cosmetically superior site for female patients. We describe a patient who underwent successful atrial myxoma resection through a previous breast augmentation inframammary incision.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Inframammary Approach to Left Atrial Myxoma Resection

Kang

Bozso

Neufeld

et al. 2020

SN Compr. Clin. Med.

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“…При цьому поєднання пухлин серця з патологією клапанів серця чи коронарних артерій значно ускладнюють клінічний перебіг захворювань у пацієнтів. У доступній медичній літературі дослідження такого поєднання представлені описом поодиноких випадків і відсутній системний аналіз [4][5][6][7][8]. Багаторічний досвід та великий клінічний матеріал дозволяє вивчити частоту ураження коронарних артерій при пухлинах серця, особливості перебігу такого захворювання, зробити необхідні висновки щодо клінічних проявів, діагностики та лікування цієї патології.…”

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“…Так, у другому випадку, швидше за Обговорення. Згідно з дослідженнями, у 10,6 % пацієнтів з пухлинами серця виявляли виражене ураження коронарних артерій, що потребує коронарної реваскуляризації на додаток до резекції новоутворення, переважно це міксоми серця [8][9][10]. Діагноз міксоми серця в багатьох випадках утруднений.…”

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“…Паранеопластичні ефекти при міксомі серця включають васкуліт, гематологічні зміни, конституціональні симптоми (біль, підвищення температури тіла, втрата ваги, арталгія, анемія) і деякі системні розлади. Імуногістохімічно виявлено, що 74 % міксом серця експресують інтерлейкін-6 [8,9]. Інтерлейкін-6 діє як прозапальний цитокін та протизапальний міокін, будучи основною речовиною гострофазової відповіді, що, відповідно, посилює несприятливий перебіг ішемічної хвороби серця при пухлинах серця.…”

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Surgical Treatment of Cardiac Tumors Combined with Coronary Pathology

Vitovskiy

Kupchynskyi

Martyshchenko

et al. 2022

ujcvs

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Introduction. Cardiac tumors (CT) occur in 0.3-0.7% of general population according to autopsies. The combination of CT with coronary artery disease (CAD) significantly complicates the clinical course of the disease. The aim. To study the frequency, features of the course and surgical treatment of patients with CT combined with CAD. Materials and methods. In the period from 01.01.1969 to 31.12.2020, surgical treatment of 976 patients with CT was performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine, and 41 (4.2%) of these patients had lesions of the coronary arteries. In 39 patients (95.1%), CT were represented by benign tumors (myxomas), in 2 (2.4%) by malignant, poorly differentiated sarcoma and immature teratoma. For the correction of the pathology of coronary vessels, a whole range of surgical methods was used: stenting of left anterior descending artery (LAD), which was performed immediately before surgery to remove CT, in 3 patients (7.3%); coronary artery bypass grafting in 35 patients (85.4%); in cases of the presence of a muscular bridge that narrowed the LAD, dissection of this structure was performed in 2 patients (4.9%); left ventricular aneurysm repair surgery in 1 patient (2.4%). In 7 patients (17.1%), the operation was performed on urgent indications. Results. The average number of grafted arteries was 1.9 ± 0.3 (1 to 4) per patient. There were no mortality. Of the 41 patients with coronary artery lesions with CT, there were 2 cases of acute CAD as a result of their embolism by tumor fragments. Clinical manifestations in these patients differed significantly. Conclusions. Occurrence of coronary artery embolism in patients with CT according to our data is 0.2% of all patients with CT. CAD accompanies tumor lesions in 4.1% of cases and is diagnosed by angiography and computed tomography. To correct the lesion of the coronary arteries in CT, the full range of surgical techniques is used, including stenting of the coronary artery (spacecraft), coronary artery bypass grafting, removal of the myocardial bridge.

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“…У дослідженні Garatti et al (2012) на 97 пацієнтів після хірургічного лікування з приводу міксоми серця мало місце 15 ускладнень (15 %): емболічні ускладнення, синдром малого викиду, фібриляції передсердь, серед іншого у 4 випадках (4 %) реєструвалася післяопераційна кровотеча. Очевидно, у цьому спостереженні мала місце кровотеча з тканин переднього середостіння, не пов'язана з анатомічними особливостями структур самого серця [8,9,10,11].…”

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Features of the Blood Supply of Cardiac Myxoma which Can Cause Bleeding

Vitovskiy

Isaienko

Pishchurin

et al. 2022

ujcvs

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With a mortality rate of 1 % to 5 %, surgical treatment of cardiac myxomas (CM) may be complicated by the development of intra- or postoperative bleeding, among other things. The aim. To present an unusual case of surgical treatment of left atrial myxoma with the occurrence of intraoperative bleeding, which was due to extremely rare features of the coronary circulation with a special blood supply to the base of the CM. Case report. Female patient R., 65 years old, case record No.3686, was admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with diagnosis of CM. Coronary angiography revealed unique features of coronary circulation: an arteriovenous malformation from the distal parts of the circumflex branch of the left coronary artery with discharge into the right parts of the heart was revealed. On 9/20/2022, urgent operation of resection of the myxoma of the left atrium (LA) was performed. After removal of the myxoma and sealing of the heart, accumulation of arterial blood was found in the area of the inferior vena cava (IVC) and the interatrialsulcus. Revision of the left atrium cavity was performed again:all intracardiac sutures in the area of the myxoma base were duplicated. After repeated resealing of the heart chambers, bleeding from the IVC region stopped after administration of protamine sulfate and tight tamponade of the space under the IVC. Tampons were removed from the pericardial cavity after 72 hours. Results. The source of the bleeding could be the site of the malformation of the coronary arteries, which is a tangle of small vessels located in the projection of the base of the myxoma below the point where the IVC meets the right atrium. During the histological examination of the myxoma, large full-blood vessels of the sinusoidal type were revealed, around which, due to damage to their thin walls, hematomas formed, giving the tumor a spotted appearance. The peculiarity of this tumor was the presence of a very large vascular plexus at its base; it had the appearance of a cluster of sections of numerous, different-sized, deformed and remodeled arteries. These data were confirmed by coronary angiography. Conclusions. Studying the data of coronary angiography with the analysis offeatures of localization of coronary arteries, as well as the presence of possible coronary malformations, can provide information that allows predicting the possibility of their damage, especially in the case of localization in the place of possible surgical manipulation. In the event of bleeding, one of the optimal methods of its elimination is the use of long-term tamponade.

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Left Atrial Myxoma Following Coronary Artery Bypass Grafting with Patient Coronary Arterial Grafts: a Rarity

Cited by 3 publications

References 3 publications

Minimally Invasive Inframammary Approach to Left Atrial Myxoma Resection

Minimally Invasive Inframammary Approach to Left Atrial Myxoma Resection

Surgical Treatment of Cardiac Tumors Combined with Coronary Pathology

Features of the Blood Supply of Cardiac Myxoma which Can Cause Bleeding

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