Massive left atrial myxoma induced congestive heart failure

Abstract

A 51-year-old female presented with a 5-month history of general weakness, fatigue, and dyspnea on exertion with increasing abdominal girth. An electrocardiogram showed normal sinus heart rhythm with left atrial enlargement. Physical examination revealed an early diastolic murmur most prominent at the apex and a pansystolic murmur.Transesophageal echocardiography revealed a large mass occupying the left atrium during systole ( Fig. 1), with occlusion of the mitral valve during diastole (Fig. 2). Severe tricuspid regurgitation was present and right heart catheterization showed pulmonary hypertension (mean pressure 44 mmHg) and elevated pulmonary capillary wedge pressure (31 mmHg).At the time of surgery, the mitral valve was exposed through the Sondergaard's groove approach and the stalk of the mass was identified lateral to the fossa ovalis and completely removed. Surgical excision revealed a 8 × 4 × 3 -cm myxoma ( Fig. 3), which required full thickness excision of the stalk as well as subsequent over-sewing of the entire fossa ovalis. Additionally, a De Vega annuloplasty of the tricuspid valve was also performed. The histopathological examination confirmed a benign cardiac myxoma consisting of myxoid soft tissue and clot with the stalk margin free from invasion. The patient had an uneventful postoperative course with immediate improvement in mean pulmonary pressure (21 mmHg), no residual tricuspid regurgitation, and no residual mass at echocardiography (Fig. 4). She was discharged on the seventh postoperative day. At 3-month follow-up, she remains asymptomatic in New York Heart Association Class I. CONFLICT OF INTERESTThe authors acknowledge no conflict of interest in the submission. How to cite this article: Gallo M, Trivedi JR, Protos AN, Slaughter MS. Massive left atrial myxoma induced congestive heart failure. J Card Surg. 2017;32:420-421. https://doi.org/10.1111/jocs.13158 FIGURE 1 Transesophageal echocardiography shows a massive myxoma in the left atrium during systole. LA, left atrium; LV, left ventricle; Myx, myxoma; RV, right ventricle FIGURE 2 Transesophageal echocardiography shows a massive myxoma occluding mitral valve during diastole. LA, left atrium; LV, left ventricle; Myx, myxoma; RV, right ventricle 420 |

Outcomes following embolization in patients with cardiac myxoma

“…Cardiac myxomas are the most common primary benign intracardiac neoplasm. Although nonspecific constitutional symptoms are common in patients with myxomas, they may also present with hemodynamic instability, intermittent syncope, congestive heart failure, pulmonary hypertension, sudden death, and systemic embolization …”

Left atrial myxoma presenting as a cystic mass

“…Left atrial myxomas may present with pulmonary hypertension, congestive heart failure, and cerebral metastases . We present a left atrial myxoma presenting as a cystic mass.…”

Localized constrictive pericarditis due to an intrapericardial myxoma

“…Cardiac myxomas may develop in the left ventricle, left atrium, and right atrium and result in outflow tract obstruction, mitral regurgitation, and congestive heart failure . We present images of an intrapericardial myxoma which resulted in localized constrictive pericarditis.…”