Coronary steal by left atrial mixoma: a case report

Álvarez, José Rubio; Quiroga, Juan Sierra; Cereijo, J.M. Martínez; López, Luciano Espino

doi:10.4076/1757-1626-2-6741

Cited by 2 publications

(4 citation statements)

References 2 publications

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“…We reviewed a number of articles on the blood supply of left atrial and right atrial myxomas. The various sources of blood supply to various myxomas reported are described in box 1 6–26The source of blood supply of some reported myxomasLeft atrial myxoma—from the right coronary artery 6–8 24…”

Section: Outcome and Follow-upmentioning

confidence: 99%

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How does knowledge of the blood supply to an intracardiac tumour help?

Gupta¹,

Sagar²,

Ramachandran³

et al. 2019

BMJ Case Rep

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Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.

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Section: Outcome and Follow-upmentioning

confidence: 99%

“…Left atrial myxoma—from the left circumflex 22Left atrial myxoma—from both the right coronary artery and left circumflex 19–21 23 25 26 …”

Section: Outcome and Follow-upmentioning

confidence: 99%

See 1 more Smart Citation

How does knowledge of the blood supply to an intracardiac tumour help?

Gupta¹,

Sagar²,

Ramachandran³

et al. 2019

BMJ Case Rep

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show abstract

“…5 The concept of coronary steal caused by atrial myxoma has been reported; however, those instances were diagnosed on the basis of patients' symptoms and the flow to the myxoma upon cardiac catheterization, without evidence of ischemia on stress testing. 6,7 To our knowledge, ours is the first report of a highly vascularized atrial myxoma that caused coronary steal with objective evidence of ischemia and subsequent resolution after resection of the mass and ligation of the anomalous coronary arteries. …”

Section: A Bmentioning

confidence: 99%

Left Atrial Myxoma Causing Coronary Steal: An Atypical Cause of Angina

Stiver¹,

Bittenbender²,

Whitson³

et al. 2015

Texas Heart Institute Journal

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A trial cardiac myxoma, a primary cardiac tumor, has a reported prevalence of 0.0017% to 0.19% at autopsy.1 Most atrial myxomas are benign and are found incidentally. If symptoms develop, they typically manifest themselves as dyspnea or as sequelae of systemic embolization. We present a case in which a car diac myxoma caused angina that was thought to be due to coronary steal. Case ReportIn May 2013, a 72yearold woman with psychological depression and a remote his tory of stroke was evaluated by her primary care physician for worsening fatigue, weakness, and exertional chest heaviness. A transthoracic echocardiogram (TTE) showed no clear abnormalities. A regadenoson nuclear stress test revealed a moder ate reversible perfusion defect in the mid and distal inferior segments that suggested coronary ischemia in the apical inferior wall. At our hospital, coronary angiography was performed. The results revealed no obstructive coronary artery disease but showed a large intracardiac mass that instantly opacified upon the administration of con trast medium. The mass was supplied by 2 anomalous arteries, one arising from the proximal left coronary artery and one from the distal right coronary artery (Fig. 1). A transesophageal echocardiogram and cardiac magnetic resonance images (MRI) confirmed the presence of a left atrial mass (Fig. 2). The initial differential diagnosis was angiosarcoma, hemangioma, or myxoma.The patient was scheduled for surgery. Standard aortic and bicaval cannulation was performed. Myocardial protection was provided by means of antegrade and retrograde administration of cardioplegic solution with topical and mild systemic cooling. The left atrium was approached though the intraatrial groove. The anomalous feeder arteries were ligated and transected. The broadbased mass, which arose from the interatrial septum onto the right superior pulmonary vein orifice, was completely resected (Fig. 3A). The right superior pulmonary vein was augmented with bovine pericardium, and the atriotomy was closed with use of 2 layers of running monofila ment suture. Histologically, the tumor was an atrial myxoma (Fig. 3B).The patient recovered uneventfully and was discharged from the hospital on post operative day 6. Upon followup examination 6 months later, her fatigue, weakness,

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Coronary steal by left atrial mixoma: a case report

Abstract: This report describes a 41-year-old man who had atypical angina resulting from coronary steal by left atrial myxoma. The tumor was completely excised and the patient was symptoms free after operation.

Cited by 2 publications

References 2 publications

How does knowledge of the blood supply to an intracardiac tumour help?

How does knowledge of the blood supply to an intracardiac tumour help?

Left Atrial Myxoma Causing Coronary Steal: An Atypical Cause of Angina

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