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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 142-143
Utility of transoesophageal echocardiography during surgery on left atrial myxoma


Department of Anaesthesiology Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

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How to cite this article:
Gadhinglajkar S, Sreedhar R. Utility of transoesophageal echocardiography during surgery on left atrial myxoma. Ann Card Anaesth 2008;11:142-3

How to cite this URL:
Gadhinglajkar S, Sreedhar R. Utility of transoesophageal echocardiography during surgery on left atrial myxoma. Ann Card Anaesth [serial online] 2008 [cited 2020 Aug 12];11:142-3. Available from: http://www.annals.in/text.asp?2008/11/2/142/41599


The Editor,

A 54-year-old female patient presented with dyspnoea on exertion and palpitations for the past 2 years, which had worsened over the last 3 months. A mass in the left atrium (LA), probably a myxoma, was detected on preoperative transthoracic echocardiography. Transoesophageal echocardiography (TOE) performed after induction of anaesthesia revealed a well-encapsulated LA myxoma of heterogeneous texture, attached to interatrial septum (IAS) and measuring 6.2 3 cm in size [Figure 1]. Moving as a single mass, it was protruding into left ventricle (LV) through the mitral valve (MV) during diastole, producing effects similar to mitral stenosis. No mitral valve regurgitation (MR) was observed [Figure 2]. The mean diastolic gradient across MV was 12 mm Hg. The tumour, free from attachment to any part of the MV, was projecting back into the LA during systole. All pulmonary veins were freely draining into the LA. The right ventricular systolic pressure (RVSP) measured by tricuspid regurgitation (TR) jet method was 38 mm Hg. There was no evidence of clot in LA appendage and myxoma in other chambers of the heart. Cardiopulmonary bypass was instituted; and after clamping the aorta and inducing cardioplegic arrest, the tumour was approached through fossa ovalis. A pedunculated and friable LA myxoma was found attached to IAS at foramen ovale. The IAS was excised around the mass and tumour was removed piecemeal. LA and LV were thoroughly washed in order to remove the remaining tumour fragments. ASD was closed using pericardial patch. After weaning the patient from CPB, TEE showed LA completely free of myxoma. The mitral valve was normally functioning, without significant MR. The RVSP using TR jet method was 26 mm Hg.

Clinical presentation of a large size LA myxoma may be similar to mitral stenosis with mitral valve inflow occlusion. [1] Mechanical damage by the movement of the tumour through the mitral valve apparatus may result in MR, which, however, may remain unnoticed on preoperative echocardiography and may manifest after the resection of myxoma. [2]

 
   References Top

1.Lanza LA, Visbal AL, DeValeria PA, Trastek VF. Giant left atrial myxoma presenting with mitral valve obstruction. Tex Heart Inst J 2002; 29:64-5.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Formica F, Sangalli F, Paolini G. Unusually large left atrial myxoma causing mitral valve occlusion and hiding a severe mitral regurgitation: A case report. Heart Surg Forum 2006;9:E849-50.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Shrinivas Gadhinglajkar
Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.41599

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  [Figure 1], [Figure 2]



 

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