Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

Abstract

A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

Giant left atrial myxoma – literature review and case presentation

“…Most frequently, the symptoms that suggest the possibility of a myxoma diagnosis are secondary to those of intracardiac obstruction (vertigo, palpitations, dyspnea, and cardiac insufficiency), which appear in up to 70% of patients. In less than 10% of cases, atrial myxomas are diagnosed incidentally and are asymptomatic [ 1 , 4 , 50 , 51 , 52 ]. In our case, the constitutional and intracardiac obstruction symptoms were absent, with our patient having only central and peripheral embolic manifestations (cerebral ischemic stroke and splenic infarction).…”

“…Early diagnosis is facilitated by non-invasive, easily accessible transthoracic echocardiography with high sensitivity (95%) for the detection of cardiac myxomas. Rapid, adequate surgical treatment prevents further complications from an embolic or a cardiac origin, such as sudden death secondary to a valvular obstruction [ 44 , 52 , 53 , 54 ].…”