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

Abstract

Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

Giant left atrial myxoma hiding severe preoperative mitral regurgitation

“…Left atrial myxomas, especially large ones with long-term evolution, may mechanically affect the mitral valve three-dimensional anatomy, by causing severe mitral stenosis or regurgitation due to a disturbance in the leaflet coaptation surface [1,2,7]. In most of cases, after a complete tumor resection, the mitral valve dysfunction disappears [1,7].…”

“…However, the left atrial myxomas themselves, could cause a permanent mitral valve dysfunction: large myxomas, with a long-term evolution, by Gregorio Laguna et al, Giant left atrial myxoma hiding severe preoperative mitral regurgitation close contact with the valve leaflets, and a prolapse into the left ventricle can produce swelling of the mitral valve, distention or rupture of the chordae tendineae [2,3], and also mitral annulus dilatation [5,8]. In this way, valvular pathology is perpetuated (usually regurgitation caused by annular dilatation or prolapse) after complete myxoma resection [2][3][4].…”

“…Large atrial myxomas can produce stenosis or mitral regurgitation. Generally, these mitral valve diseases tend to be reversible and disappear following the tumor resection [2], however, large myxomas with long-term evolution may permanently affect the mitral valve structure and may cause persisting damage of the valve after complete resection of the tumor [2][3][4].…”

“…At the same time, atrial myxomas may conceal or underestimate a preoperative mitral regurgitation, from any cause [1,2,5,6].…”

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

“…Planned scheduled follow-up is of great importance in ruling out the possibility of a tumor reoccurrence even after proper surgical therapy employed. Cardiac computed tomography, magnetic resonance imaging, Doppler assessment and a combination of both outpatient transthoracic echocardiography with intra and postoperative Transesophageal echocardiography are essential for identifying and grading the regurgitation which is essential for an adequate left atrial myxoma therapy as they help in making precise judgment and assessment of anatomical valvular structures, which are destroyed by the tumor and are easily missed as most regurgitation are masked by the sole presence of LAM, different loading conditions, body structure and position [1,[12][13][14][15][16][17][18][19][20][21][22][23][24].…”