Myxoma of the Left Atrium

Wassermil, Mendel; Warkentin, Donald L.; Ravin, Abe

doi:10.1161/01.cir.25.1.50

Cited by 19 publications

(1 citation statement)

References 6 publications

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“…[4][5][6][7][8][9][10][11] The loud late elements of the first sound in our two patients were possibly contributed to by tumor movement, either through checking of the tumor by the stalk or perhaps striking of the atrial wall or mitral valve by the tumor, as has been suggested by Wassermil et al'0 It has been suggested that the loudness of the first sound is a result of the large atrioventricular pressure difference at the time of ventricular isometric contraction. '0…”

Section: Discussionsupporting

confidence: 62%

Myxoma of the Left Atrium

Pitt

et al. 1967

Circulation

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Two patients with myxoma of the left atrium were studied by left heart catheterization and cineangiography, and the diagnosis was confirmed at operation in both cases. An electrocardiographic timing signal on the cineradiographs permitted correlation of heart sounds and pressure waves with movement of the tumor between the left atrium and the left ventricle. In early systole, the tumor suddenly moved from the left ventricle to the left atrium, and a notch in the rising left ventricular pressure, a prominent c wave, and loud, late elements of the first sound were noted. In early diastole, the tumor moved rapidly through the mitral valve, causing an abrupt diminution in the left atrial volume, thus causing a rapid y descent despite severe obstruction of the mitral valve. An early diastolic sound, thought to be an opening snap, appeared to be related to the checking of the tumor in the left ventricle ("tumor plop").The unusual left atrial pressure pulse seen in these two cases resembles data from other cases of myxoma reported in the literature, and recognition of these unusual pressures may permit accurate preoperative diagnosis in other patients. Diagnostic changes may be present on apexcardiograms.

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Section: Discussionsupporting

confidence: 62%

Myxoma of the Left Atrium

Pitt

et al. 1967

Circulation

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Left Atrial Myxoma

Craige¹

1972

Arch Intern Med

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The presence of a left atrial (LA) myxoma may be suspected where there are symptoms and signs consistent with mitral valve disease of a relentlessly progressive nature, often accompanied by syncope or embolization.1 Alterations in symptomatology and physical signs, with changes in posture and constitutional manifestations suggestive of a chronic inflammatory process are also frequently found. Nevertheless, the diagnosis of LA myxoma continues to be made too often for the first time at surgery for suspected mitral stenosis, or at autopsy.Recently, clues to the diagnosis of LA myxoma by phonocardiography and apexcardiography have been described.2-7 These may facilitate the early diagnosis of this surgically curable condition. This report deals with a patient in whom the diagnosis was suspected from characteristic findings in the records of heart sounds and precordial movement. Detailed simultaneous pressure recordings in the left atrium and ventricle at cardiac catheterization permitted an analysis of physiologic correlates of the external findings. Patient Summary A 37-year-old man had the onset of dyspnea on exertion six months before ad¬ mission. There was no prior history of a heart murmur or rheumatic fever. Two months after onset of symptoms a heart murmur was heard for the first time. A month later he had an episode of pneu¬ monia which was complicated by lung ab¬ scess. This resulted in hospitalization at North Carolina Memorial Hospital where murmurs suggestive of mitral stenosis and insufficiency were heard. His dyspnea had become completely disabling, but at no time was there any dizziness or syncope. Symptoms were not affected by postural changes. Arrangements were made for his readmission for cardiac catheterization on subsidence of the pulmonary condition.On physical examination he was a well developed young man with normal color and no rash or fever. Blood pressure was 110/70 mm Hg. The neck veins were nor¬ mal, as were the carotid pulsations. The chest was clear, the heart not enlarged to the left. The apex movement felt normal, but it was initiated by a palpable first heart sound. There was a heave consistent with right ventricular hypertrophy at the left sternal edge. The first heart sound was unusually loud and had a crescendo con-figuration by auscultation which gave an acoustical impression of a presystolic mur¬ mur (Fig 1). The second heart sound split normally, but the pulmonary component was accentuated. A grade 2 holosystolic murmur was audible at the apex with transmission to the axilla. A loud third sound was present at the apex, but no diastolic murmur could be heard. X-ray films (Fig 2) showed a silhouette consistent with mitral disease: an enlarge¬ ment of the pulmonary outflow tract, left atrium, and right ventricle, along with some evidence of pulmonary vascular con¬ gestion. The electrocardiogram (Fig 3) was also consistent with LA enlargement and showed right axis deviation and early right ventricular hypertrophy.A phonocardiogram (Fig 1) showed a prolonged loud S, with an unusual ...

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“Vegetation plop”—Auscultatory findings in large mitral valve vegetation

Kalaria

Schwarz

Eichelberger

et al. 2000

Clinical Cardiology

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A 61-year-old man with history of hypertension, diabetes mellitus, and end-stage renal dysfunction on hemodialysis was admitted with low-grade fever. Cardiac examination on admission revealed normal first and second heart sounds, and a soft, grade 2/6 ejection systolic murmur at the left upper parasternal border. Blood cultures grew oxacillin-resistant Staphylococcus Aureus (ORSA). Duplex ultrasound imaging of the arteriovenous fistula revealed a fluid collection suggestive of abscess, prompting surgical removal of the fistula. A transthoracic echocardiogram performed on Day 3 of admission did not reveal any vegetation (despite high-quality har- monic frequency imaging). The patient's cardiac examination over next few days revealed new and variable auscultatory findings. The first heart sound was more pronounced and a new intermittent low-pitched diastolic sound with a variable diastolic murmur was noted at the left upper parasternal border. The intensity of the diastolic murmur changed from being inaudible to moderately high (3/6), and the timing changed from mid-diastolic to presystolic. The patient continued to be febrile and had persistent ORSA in blood cultures despite aggressive antibiotic treatment. A transesophageal echocardiogram performed on Day 12 of hospitalization revealed large vegetation (2.5 X I .6 cm) on the posterior mitral valve leaflet (Fig. 1, A, B). Transthoracic imaging on the same day also showed the large vegetation (even with medium quality fundamental frequency imaging).These changing cardiac auscultatory findings were attributed to the possible presence of large mitral valve vegetation. A phonocardiogram recorded with simultaneous two-dimensional transthoracic echocardiogram confirmed the occurrence of the intermittent diastolic sound ("vegetation plop") coinciding with the physical movement of vegetation across the mitral valve apparatus, and a variable diastolic murmur (Fig. 2, A, B).Left atrial myxoma has been described to have similar auscultatory findings, including a variable diastolic murmur and a diastolic sound mimicking an opening snap.' The possible

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Myxoma of the Left Atrium

Cited by 19 publications

References 6 publications

Myxoma of the Left Atrium

Myxoma of the Left Atrium

Left Atrial Myxoma

“Vegetation plop”—Auscultatory findings in large mitral valve vegetation

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