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

Abstract

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.

A Rare Case of Cavernous Hemangioma of the Mitral Valve Presenting As Multifocal Embolic Brain Infarcts

“…About 50 cases of cardiac hemangiomas have been reported in the literature. However, to the best of our knowledge and research, less than 15 cases of surgically treated cavernous hemangiomas of the MV have been reported in the medical literature so far [1][2][3][4][5][6][7][8][9][10].…”

“…It is generally difficult to differentiate between different types of intracardiac mass on imaging. Common differentials include benign papillary fibroelastomas, myxomas, intracardiac thrombus, rhabdomyoma, fibromas, hemangiomas, teratomas, lipomas, cardiac hamartomas, intracardiac pheochromocytomas and paragangliomas [ 1 , 2 ]. Cardiac hemangiomas are rare benign heart neoplasms.…”

“…Their presentation depends upon the location, mobility, and size of the tumor. Important clinical implications include thromboembolic events, heart failure due to flow obstruction, suspicion of infective endocarditis, syncope, pseudo-angina, and arrhythmia [ 1 , 2 ]. In some cases, they can also invade the lung and cause pulmonary symptoms [ 3 ].…”

“…Fewer than 50 cases of cardiac hemangiomas are reported in the literature. On further literature search, less than 15 mitral valve (MV) hemangiomas have been reported to date [1][2][3][4][5][6][7][8][9][10]. It is hard to differentiate hemangioma from other benign heart neoplasms clinically or through imaging studies.…”