Left atrial myxoma presenting with myocardial infarction

Panos, Aristotelis; Kalangos, Afksendiyos; Sztajzel, Juan

doi:10.1016/s0167-5273(97)00178-2

Cited by 67 publications

(39 citation statements)

References 4 publications

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“…The infrequency with which coronary embolization occurs can be explained by the nearly perpendicular relationship of the coronary ostia and the aortic root, filling of the coronary arteries during ventricular diastole, and shielding of the coronary ostia by the aortic valve leaflets during ventricular systole. 5,6 As reported by her family, our patient had experienced constitutional symptoms (fever, chills, and mild weight loss), probably related to the myxoma, in the months before presentation. These systemic symptoms are mediated through increased interleukin-6 release from myxoma cells.…”

Section: Discussionsupporting

confidence: 56%

Catastrophic Systemic Embolization from a Left Atrial Myxoma

Mackie¹,

Shirazi²,

Swadley³

et al. 2014

Texas Heart Institute Journal

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We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old W hen a patient presents with simultaneous vascular insults that involve multiple organ systems, a catastrophic clinical outcome can result. We report the case of a patient who had symptoms of systemic embolization, and we discuss the presentation, recognition, and treatment of the left atrial myxoma that was responsible. Case ReportA 39-year-old black woman was found unresponsive and in respiratory distress outside her home. According to her family, she had felt fatigued over the past 2 months and had occasionally reported fevers and night sweats. She had been taking oral contraceptive pills and smoked half a pack of cigarettes per day. Her personal and family medical histories yielded nothing else of note.Upon evaluation by emergency medical personnel, the patient was unconscious, tachypneic, and displaying possible seizure activity. In the emergency department, the patient was comatose with a Glasgow coma scale of 5, a temperature of 37 °C, a blood pressure of 117/77 mmHg, a heart rate of 133 beats/min, a respiratory rate of 30 breaths/min, and an oxygen saturation of 76% on room air. She was immediately intubated. A 12-lead electrocardiogram revealed 2-to 4-mm ST-segment elevation in the lateral leads, consistent with acute ST-elevation myocardial infarction (STEMI). Pertinent laboratory values included a cardiac troponin I level of 1.6 ng/mL, a white blood cell count of 13,800/µL, and an international normalized ratio of 1.21. The patient was anuric. A chest radiograph showed a normal cardiac silhouette with bilateral pulmonary edema. Aspirin (325 mg) was administered through a nasogastric tube, and an intravenous heparin drip was initiated. The diagnosis was cardiac arrest secondary to STEMI. A noncontrast computed tomographic scan of the patient's head was performed, and she was sent for emergent cardiac catheterization.Femoral arterial access was difficult to achieve in either groin because of the aspiration of thrombotic material. A 4F sheath was finally placed in the right femoral artery; the access sheath thrombosed twice during the procedure, necessitating the aspiration of large amounts of dark-red thrombus. Coronary angiograms obtained with use of 4F catheters showed abrupt thrombotic occlusion of the proximal-to-mid left anterior descending coronary artery, first diagonal branch, and proximal-to-mid left circumflex coronary artery (Fig. 1). The right coronary artery was angiographically normal. The occlusions were not suitable for catheter aspiration, balloon angioplasty, or stenting. A left ventriculogram showed a left ventricular ejection fraction (LVEF) of 0.30 and akinesis of the anterolateral, inferolateral, and apical walls. The computed tomographic report, received during the cardiac catheterization procedure, noted a large, acute embolic infarct in the region of the left middle cerebral artery. In view of the substantial thrombotic...

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Section: Discussionsupporting

confidence: 56%

Catastrophic Systemic Embolization from a Left Atrial Myxoma

Mackie¹,

Shirazi²,

Swadley³

et al. 2014

Texas Heart Institute Journal

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“…2 Rarely, patients present with myocardial infarction caused by coronary embolization. 3 When atrial myxomas are seen incidentally during coronary angiography, they can appear as a blush from an anomalous artery that arises from a coronary artery. However, in our patient, the mass was easily seen as a highly vascularized structure that was fed by 2 anoma lous arteries.…”

Section: Discussionmentioning

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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“…Especially after the age of 35, the co-incidence of atrial myxomas with ischemic heart disease without an evidenced etiopathology increases [11]. Very rarely, in patients with atrial myxoma presenting with myocardial infarction, it has been shown that the infarction resulted from the embolization particles from the pedicle of the myxoma [12,13]. Nevertheless, when both disorders account concomitantly, ideal treatment should include same session surgery.…”

Section: Discussionmentioning

confidence: 99%

Concomittant Coronary Revascularization and Resection of a Cardiac Tumor

Mansuroğlu¹,

Sever²,

Uğurlucan³

et al. 2009

TOCTSJ

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Ischemic cardiac diseases are the leading causes of mortality in the developed and developing regions of the world. Although vascular problems may accompany coronary artery disease, association of primary cardiac tumors with ischemic heart disease and the treatment of the combination are rarely reported in the literature. This report presents a male patient who successfully underwent concomitant coronary artery bypass grafting with resection of right atrial myxoma.In this report, we present a case of ischemic heart disease and myxoma treated successfully in the same surgical session.

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Left atrial myxoma presenting with myocardial infarction

Cited by 67 publications

References 4 publications

Catastrophic Systemic Embolization from a Left Atrial Myxoma

Catastrophic Systemic Embolization from a Left Atrial Myxoma

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

Concomittant Coronary Revascularization and Resection of a Cardiac Tumor

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