Catheters, coils, cathlab crashes—New vistas for cardiac surgery

Abstract

Introduction:Left Atrial tumors are known to present in congestive heart failure by their propensity to block flow in the left heart. Myxomas are commoner of these tumors; however other tumors have to be considered. Left atrial myxomas warrant an emergency surgery, however a thorough workup is emphasized even in an emergency.Case Report: A 35 year lady presented to the emergency department with acute congestive heart failure. CXR showed cardiomegaly and florid pulmonary edema. An echocardiogram revealed a 43x33mmleft atrial myxoma (Charuzi class III) and pulmonary hypertension. Since she was too sick, for emergency surgery, medical stabilization was done. A repeat CXR showed clearing of pulmonary edema but also a persistent suspicious opacity in the left upper lung zone. Computed tomography of thorax revealed a mass extending from the arch of aorta into the left atrium and ventricle. Computed tomography guided needle biopsy of the mass showed presence of a primary synovial sarcoma.Conclusions: LA myxomas presenting with congestive heart failure often require emergency surgery. However through evaluation prior to surgery cannot be substituted. Presence of florid pulmonary edema on chest x-ray can mask other lung lesions especially metastasis. In such instances further investigations are necessary to make the correct diagnosis.