Year : 2013  |  Volume : 16  |  Issue : 1  |  Page : 66--67

Solid ovoid left atrial myxoma


Sarvesh Pal Singh1, Sandeep Chauhan1, Richa Chauhan2,  
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

Correspondence Address:
Sarvesh Pal Singh
Department of Cardiac Anaesthesia, 7th Floor, C N Center, AIIMS, New Delhi- 110 029
India




How to cite this article:
Singh SP, Chauhan S, Chauhan R. Solid ovoid left atrial myxoma.Ann Card Anaesth 2013;16:66-67


How to cite this URL:
Singh SP, Chauhan S, Chauhan R. Solid ovoid left atrial myxoma. Ann Card Anaesth [serial online] 2013 [cited 2021 Jan 16 ];16:66-67
Available from: https://www.annals.in/text.asp?2013/16/1/66/105376


Full Text

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}{Figure 2}

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

1Shapiro LM. Cardiac tumors: Diagnosis and management. Heart 2001;85:218-22.
2Shimono 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.
3Oliver WC, Nuttall GA. Uncommon cardiac diseases. In: Kaplan JA, editor. Kaplan's Cardiac Anesthesia. 5 th ed. Philadelphia: Elsevier Saunders; 2006. p. 767.