Calcified left atrial myxoma with floppy mitral valve.

Abstract

SUMMARY A heavily calcified left atrial myxoma in a man aged 53 was diagnosed from the plain chest xray film and confirmed by echocardiography. There was also moderate mitral regurgitation caused by a floppy mitral valve. Before a systemic embolus is considered to have arisen from a floppy mitral valve, echocardiography must be performed.Myxomata of the left atrium usually present with the features of mitral valve obstruction, systemic emboli, or constitutional symptoms (Goodwin, 1963). Mitral regurgitation is a rare presenting feature (Penny et al., 1967). We report the case of a patient who presented with cerebral embolism and the signs of mitral regurgitation, in whom a calcified left atrial myxoma was found by x-ray film and echocardiography. Case reportA 53-year-old man was referred for consideration of mitral valve replacement for mitral regurgitation. He was thought to have had rheumatic fever as a child and mitral murmurs had been present for at least 20 years. He was seen by a physician in 1971 for dyspepsia and was thought to have mitral regurgitation. He was then in sinus rhythm. Three months before admission to this unit he had been admitted elsewhere with a right hemiparesis which was thought to be caused by a cerebral embolus associated with the onset of atrial fibrillation. He had made a complete neurological recovery but complained of dyspnoea on moderate effort.On examination there was atrial fibrillation, all the peripheral pulses were present and normal, blood pressure 140/80 mmHg. The jugular venous pressure and pulse were normal. There was a moderately increased, dynamic, left ventricular impulse palpable at the anterior axillary line. A grade 2/4 apical pansystolic murmur with late crescendo radiated to the axilla. There was a soft short mitral diastolic murmur. The electrocardiogram confirmed atrial fibrillation and showed unifocal ventricular extrasystoles. The chest x-ray film (Fig. 1) showed a calcified mass within the left atrium. A diagnosis of a moderate mitral regurgitation with a calcified left atrial myxoma or thrombus was made. Echocardiography ( Fig. 2a and 2b) suggested mitral valve prolapse and confirmed a dense mass in the left atrium which did not pass through the mitral valve in diastole. The haemoglobin was 15 1 g/dl and the white blood cell count, platelets, and plasma proteins were normal. The ESR was 33 mm in one hour.Operation was performed without further investigation. The left atrium was found to contain a hard smooth, yellowish tumour measuring 5 cm by 2-5 cm. The mass was attached by a short pedicle to the posterior left atrial wall just below and medial to the right inferior pulmonary vein and 2 cm from the mitral valve. It was excised, together with its )8

Left ventricular outflow tract myxoma accompanied by dextrocardia with situs inversus: a case report

“…Calcification can be evident in the tumor even on a routine chest film, [10] but the chest X-ray of the patient failed to demonstrate any sign of calcification. The value of ultrasound in the noninvasive diagnosis of intracavitary tumors has been well documented [11][12][13] whereas techniques such as CT has been used to achieve excellent visualization of intracavitary myxomas, providing information about size, shape and attachment of these tumors.…”

Mitral Valve Insufficiency, a Constituent of Left Atrial Myxoma: Pathobiology, Physiopathology, and Pathophysiology of Left Atrial Myxoma; Are Long-Term Results Still Feasible?

“…However, the extent of valvular obstruction varies with body position as the presence of the myxoma body itself affects transmitral blood flow and also tends to mask mild and moderate to severe mitral regurgitations due to the huge and floating myxoma body where large myxomas with long stalk produces a temporally complete obstruction of the mitral valve orifice resulting in syncope. The continuous pendulum like or "wrecking ball" effect of the myxoma during each cardiac circle against the entirety of the mitral valve apparatus gives raise to regurgitations and its severity is highly dependent on the resultant effect of the myxoma body itself on the mitral valve [26][27][28][29][30][31][32][33][34][35]. The grade and severity of the regurgitation is highly dependent on the myxomas body size, stalk length [small, large, prolapsing and non-prolapsing] and to some varying degree body position and the resultant changes of blood flow through the left heart [36].…”

Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease

“…Less commonly, MR can be due to direct damage of leaflets or subvalvular apparatus by the tumor. [4,5] A large LA myxoma may manifest with angina in the absence of coronary artery disease (CAD) due to coronary steal phenomenon; [6] however, CAD may be co-existent due to associated atherosclerosis or due to embolization of tumor fragments in to the coronary artery. We describe an uncommon association of LA myxoma, CAD and chronic MR; the MR was diagnosed as "mild" on pre-operative echocardiography carried out previously.…”

“…LA myxoma can also be associated with mitral regurgitation (MR), [1][2][3][4][5] which is often attributed to failure of leaflet coaptation due to the tumor itself. Less commonly, MR can be due to direct damage of leaflets or subvalvular apparatus by the tumor.…”