A Left Atrial Myxoma Complicated with Acute Myocardial Infarction.

Abstract

A 43-year-old female, admitted because of acute infero-posterior myocardial infarction, showed angiographic findings of 100%occlusion of left circumflex artery. Echocardiographic findings showedinferior hypokinesis, while a large left intraatrial tumor was also observed. The coronary angiography on the 17th hospital day showed complete reperfusion of the culprit lesion without stenosis. On the 21st hospital day, the removal operation of the tumor was performed. Pathological findings showed typical cardiac myxoma,and the etiology of the occlusion at the culprit vessel was presumed to be closely related to the existence of the left atrial tumor. (Internal Medicine 36: 31-34, 1997) Key words: coronary embolism, left atrial tumor, complete later reperfusion Case Report Wetreated a rare case of left atrial myxoma complicated with acute inferior and posterior myocardial infarction. A 43-year-old female was admitted to our emergency service 100 minutes after the onset of severe chest pain. Physical findings showed a height of 158 cm, weight of 54 kg, body temperature of 36.9°C, regular pulsation of 70/min, and blood pressure of 1 06/70 mmHg. She had no lymphadenopathy or pretibial edema.Auscultation showed systolic ejection murmurand diastolic rumble at the precordial apical portion, and normal vesicular sound with no rales. Abdomenwas soft and flat without any mass palpable. Laboratory findings showed a white blood cell count of 8,700/mm3, hemoglobin 1 1.0 mg/dl, hematocrit 36.8%, platelet 28.7xlO4/mm3, glutamic oxalacetic transaminase 2 1 1 U//, lactic dehydrogenase 348 IU//, creatinine phosphokinase 62 IU//, myoglobin 329 ng/dl, creatinine 0.8 mg/dl, sodium 142 mEq//, potassium 3.5 mEq//, chloride 107 mEq//. Analysis of arterial blood gas during 3 //rnin of pure oxygen gas supply revealed PO2 1 34 mmHg, PCO2 22mmHg, HCO3 23 mEq//. On electrocardiogram, a normal sinus rhythm with ST elevation at II, III, aVf leads, and ST depression with T wave inversion at V1-V4leads were observed. There was no abnormal finding on the chest X-ray picture. She was then diagnosed as having acute myocardial infarction of the inferior and posterior walls, and emergency coronary angiography was done immediately. The angiography demonstrated normal left anterior descending and right coronary artery, and complete occlusion of the left circumflex #1 3 (Fig. 1A). Intracoronary administration of tissue plasminogen activator (t-PA) failed to reperfuse the culprit lesion and the continuous infusion of heparin was started thereafter. On the echocardiogram, inferior hypokinesis of the left ventricular wall wasseen, while a large solid masswas observed inside the left atrium, and the mass was attached to the interatrial septum by a stalk (Fig. 2). The maximumvalue of creatinine phosphokinase was 744 IU//; the patient was free from any complication during the course. On the 17th hospital day, a cardiac catheterization examination was done. Central venous pressure was 6 mmHg, pulmonary capillary wedge pressure 14 mmHg,and the cardiac index 2. 1 /...

Unremitting embolus from cardiac myxoma at circumflex artery trifurcation

“…The thesis on spontaneous degradation of myxomatous embolus is supported by the case report [5] of patient with occluded coronary artery after failure of a fibrinolytic attempt (excluding thrombotic embolisation by this), but with complete reperfusion at repeated coronary angiography 17 days later. Beside this one, Braun et al [2] reviewed two more cases of myxomatous embolisation with possible spontaneous recanalisation.…”

Left Atrial Myxoma Complicated with an Acute Upper Extremity Embolism

“…Intracardiac obstruction and constitutional symptoms -fatigue, arrhythmia, erythematous rash, fever, arthralgia, and weight loss -are the most reported abnormalities. [1][2][3][4][5] A case of left atrial myxoma, complicated with acute upper extremity ischemia, such as in the present case, is very rare, and to the best of our knowledge only 10 cases have been reported in the literature among 4396 reports of myxoma. 6) Embolization resulting from fragmentation or complete tumor detachment occurs in up to 30% of cases.…”

Left atrial myxoma associated with acute myocardial infarction and multiple cerebral infarctions: Report of a case

“…Concomitant coronary artery bypass grafting with excision of the myxoma was performed in only 8 cases. Some cases of complete and spontaneous recanalization of the affected coronary artery have been reported [12][13][14] and the rate of recanalization caused by necrolysis, spontaneous lysis, or fragmentation may be high for coronary embolism resulting from a myxoma.…”