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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
LETTER TO EDITOR  
Year : 2013  |  Volume : 16  |  Issue : 1  |  Page : 66-67
Solid ovoid left atrial myxoma


1 Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, Lady Hardinge Medical College, New Delhi, India

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Date of Web Publication2-Jan-2013
 

How to cite this article:
Singh SP, Chauhan S, Chauhan R. Solid ovoid left atrial myxoma. Ann Card Anaesth 2013;16:66-7

How to cite this URL:
Singh SP, Chauhan S, Chauhan R. Solid ovoid left atrial myxoma. Ann Card Anaesth [serial online] 2013 [cited 2019 Nov 20];16:66-7. Available from: http://www.annals.in/text.asp?2013/16/1/66/105376


The Editor,

A 45-year-old woman, weighing 35 kg, presented to the emergency department with complaints of fever, weight loss, and dyspnea (class IV). She was in congestive heart failure. Transthoracic echocardiography revealed a left atrial (LA) myxoma and severe mitral regurgitation (MR). There was no history of rheumatic fever in the childhood. The patient was taken up for surgery, and after induction of anesthesia, a transesophageal echocardiographic (TEE) examination was done. TEE showed a pedunculated solid, ovoid tumor measuring 5.6 × 6.5 cm projecting into LA from the interatrial septum. The tumor was calcified and showed multiple acoustic shadows. The anterior mitral leaflet (AML) was thickened and the A2 segment of the AML was prolapsing into the LA causing severe MR [Figure 1]a and b. Intraoperatively, a solid ovoid tumor was resected along with its stalk attached to the interatrial septum [Figure 2]. The mitral valve was replaced with a 31- mm mitral valve prosthesis (ATS Medical Inc., Minneapolis, Minnesota, USA) and the atrial septal defect created by excision of the myxoma was closed with a dacron patch. The cut section of the tumor showed myxoid change with areas of hemorrhage and calcification. Histopathology of the tumor confirmed a cardiac myxoma. Mitral valve specimen showed diffuse fibrosis with Aschoff nodules, establishing a diagnosis of chronic rheumatic heart disease with LA myxoma.
Figure 1: (a) Myxoma in left atrium with calcification specks and thickened anterior mitral leaflet. (b) Mid esophageal four chamber view shows severe mitral regurgitation on color Doppler

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Figure 2: Large solid ovoid myxoma

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Approximately 45% of tumors in heart are myxomas. [1] Myxomas arise from undifferentiated cells in the fossa ovalis and project as a pedunculated mass, most commonly, in the LA. Myxomas are of two types - either solid, ovoid, and smooth, or soft, papillary, and irregularly shaped. Constitutional symptoms such as fever, fatigue, and weight loss are common with both the types. Dyspnea, however, is common with solid ovoid tumors whereas neurologic symptoms are more common with the papillary myxomas. [2] Solid myxomas may have resemblance to other cardiac tumors (e.g., sarcomas, hemangiomas) on echocardiography. TEE is 100% sensitive for diagnosis of LA myxoma, and gives detailed information about its attachment, mobility, and morphology. [3]

 
   References Top

1.Shapiro LM. Cardiac tumors: Diagnosis and management. Heart 2001;85:218-22.  Back to cited text no. 1
[PUBMED]    
2.Shimono T, Makino S, Kanamori Y, Kinoshita T, Yada I. Left atrial myxomas. Using gross anatomic tumor types to determine clinical features and coronary angiographic findings. Chest 1995;107:674-9.  Back to cited text no. 2
[PUBMED]    
3.Oliver WC, Nuttall GA. Uncommon cardiac diseases. In: Kaplan JA, editor. Kaplan's Cardiac Anesthesia. 5 th ed. Philadelphia: Elsevier Saunders; 2006. p. 767.  Back to cited text no. 3
    

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Correspondence Address:
Sarvesh Pal Singh
Department of Cardiac Anaesthesia, 7th Floor, C N Center, AIIMS, New Delhi- 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.105376

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