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Zhang S, Wang J, Song F, Yang F, Li F, Liu S, Ma J, Zhang H, Ma X. Case report: Left atrial myxoma with morphology of cavernous hemangioma supplied by the right coronary artery. Front Cardiovasc Med 2023; 10:1207339. [PMID: 37593147 PMCID: PMC10427500 DOI: 10.3389/fcvm.2023.1207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Here, we report an unusual case of left atrial myxoma presented with morphology of cavernous hemangioma supplied by the right coronary artery. Surgical resection of the left atrium myxoma was performed, and the patient experienced an uneventful recovery during hospitalization.
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Affiliation(s)
- Shouji Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Junlin Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fahang Song
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fan Yang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Fang Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shangxin Liu
- Imaging Department, Pingyin Chinese Medicine Hospital, Jinan, China
| | - Jiwei Ma
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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2
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Javaid A, Khandait H, Ong CK. Left atrial myxoma with coronary artery disease. BMJ Case Rep 2022; 15:e252905. [PMID: 36316054 PMCID: PMC9628531 DOI: 10.1136/bcr-2022-252905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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3
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Peng X, Xiao Y, Guo Y, Zhu Z, Liao L, Liao X, Hu X, Fang Z, Li X, Zhou S. Clinical Significance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Myxomas are the most common primary cardiac tumors. Angiographically detectable neovascularity (ADN) of myxoma is increasingly being reported as a result of the use of coronary angiography (CAG) to detect coronary artery disease. However, the clinical significance
of these findings is not fully understood.Methods: We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018. Patients were followed up for a mean of 28.9 months (range 1‐69 months). The clinical features, echocardiography measurements,
pathological examination findings, CAG results, and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results: ADN was found in 25 patients (42.4%). The arteries feeding the ADN included the right coronary artery (n=15), the left circumflex
coronary artery (n=7), and both arteries (n=3). The patients with ADN had a higher proportion of eosinophils (3.2% vs. 2.2%, P=0.03) and higher low-density lipoprotein cholesterol level (2.7 mmol/L vs. 2.2 mmol/L, P=0.02). Myxoma pedicles were more likely to be located in the
interatrial septum in patients with ADN (96% vs. 73.5%, P=0.02). No significant correlation was observed between the groups in clinical manifestations, atrial arrhythmia, myxoma size, cardiac chamber size, left ventricular ejection fraction, and the prevalence of complication with coronary
artery disease [16% in the ADN group (n=4) vs. 20.6% in the non-ADN group (n=7), P=0.66]. However, patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up (0% vs. 14.7%, P=0.07).Conclusion: CAG-detected
ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.
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Affiliation(s)
- Xiaofan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanan Guo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaobo Liao
- Department of Cardiovascular and Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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4
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Garg A, Agrawal D, Sharma GL. Right Atrial Myxoma with Coexistent Coronary Artery Disease - A Rare Combination. J Cardiovasc Echogr 2020; 30:100-103. [PMID: 33282648 PMCID: PMC7706367 DOI: 10.4103/jcecho.jcecho_73_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/08/2020] [Accepted: 03/16/2020] [Indexed: 11/22/2022] Open
Abstract
Atrial myxomas are the most common primary heart tumors. Two-dimensional echocardiography is the diagnostic procedure of choice. The majority of myxomas are located in the left atrium. Myxoma in the right atrium is an uncommon location. The co-occurrence of right atrial myxoma with atherosclerotic coronary artery disease (CAD) is uncommon. In our case, right atrial myxoma was associated with CAD, which makes it a unique case because very few cases of right atrial myxoma coexistent with CAD are described in literature.
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Affiliation(s)
- Ashok Garg
- Department of Preventive and Noninvasive Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - Deepak Agrawal
- Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - G L Sharma
- Department of Cardiology, Jaipur Heart Institute, Jaipur, Rajasthan, India
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5
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Velasco CE, Suarez NP, Roullard CP, McCullough PA, Roberts WC. Usefulness of coronary angiography in patients with left atrial myxoma. Proc (Bayl Univ Med Cent) 2020; 33:529-531. [DOI: 10.1080/08998280.2020.1776024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Carlos E. Velasco
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- College of Medicine, Texas A&M Health Science Center Dallas Campus, Dallas, Texas
| | | | | | - Peter A. McCullough
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- College of Medicine, Texas A&M Health Science Center Dallas Campus, Dallas, Texas
| | - William C. Roberts
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- College of Medicine, Texas A&M Health Science Center Dallas Campus, Dallas, Texas
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6
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Lee SY, Lee SH, Jung SM, Choi JH, Chon MK, Hwang KW, Kim JS, Park YH, Kim JH, Chun KJ, Je HG, Park JS. Value of Coronary Angiography in the Cardiac Myxoma. Clin Anat 2019; 33:833-838. [PMID: 31749186 DOI: 10.1002/ca.23527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/15/2019] [Indexed: 11/08/2022]
Abstract
Preoperative coronary angiography for cardiac myxoma not only excludes coronary artery disease but also detects the artery feeding the cardiac myxoma, which has several clinical implications. In this study, we examined cardiac myxoma cases in two tertiary hospitals using coronary angiography to identify the artery feeding the myxoma. We retrospectively reviewed 42 patients with cardiac myxoma who had undergone surgical removal between July 2008 and December 2015 in two tertiary hospitals, and recorded their baseline characteristics, echocardiographic findings, and coronary angiography. Among those 42 patients, 23 (55%) had coronary angiography before surgery and in no case was significant luminal narrowing observed. In 21 of the coronary angiograms, the artery feeding the cardiac myxoma had a vascular branch (100%), clusters of tortuous vessels with contrast medium pooling (67%), an arteriocavity fistula (33%), and a mobile feeding artery (67%). No significant relationship was found between coronary artery dominance type and the origin of the artery feeding the cardiac myxoma (P = 0.362). Identification of the artery feeding the cardiac myxoma, with a distinctive vascular appearance in coronary angiography, is important for several clinical applications such as helping to diagnose cardiac myxoma and to plan the surgical approach. Clin. Anat. 33:833-838, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Soo Yong Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soon Myung Jung
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin Hee Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min Ku Chon
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jeong Su Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong Hyun Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyung Gon Je
- Department of Cardiovascular and Thoracic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin Sup Park
- Department of Cardiology, Pusan National University Hospital, Busan, Republic of Korea
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7
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Lalla S, Kawall J, Seecheran R, Ramadhin D, Seecheran V, Persad S, Seecheran NA. Atrial myxoma presenting as a non-ST-segment elevation myocardial infarction. Int Med Case Rep J 2019; 12:179-183. [PMID: 31354366 PMCID: PMC6590630 DOI: 10.2147/imcrj.s207448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
Cardiac myxomas are the most common benign tumors of the heart. We describe the rare phenomenon of myxomatous embolization, resulting in a non-ST-elevation myocardial infarction treated successfully with surgical excision. The routine early use of both transthoracic and transesophageal echocardiography is pivotal in selecting an optimal management strategy for these patients.
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Affiliation(s)
- Sasha Lalla
- Cardiology Unit, Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Jessica Kawall
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Divya Ramadhin
- Cardiology Unit, Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Sangeeta Persad
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
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8
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Balci AY, Sargin M, Akansel S, Ünal Dayi S, Kuplay H, Mete ME, Orhan G, Aykut Aka S. The importance of mass diameter in decision-making for preoperative coronary angiography in myxoma patients. Interact Cardiovasc Thorac Surg 2019; 28:52-57. [PMID: 30010840 DOI: 10.1093/icvts/ivy217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although coronary angiography (CAG) is generally performed to rule out coexisting coronary artery disease in patients with cardiac myxoma, its necessity to evaluate vascular supply of the myxoma is debatable. The aim of this article is to evaluate clinical experience and CAG findings in our patient group. METHODS This retrospective analysis was performed in 46 patients (17 men, mean age 57.7 ± 8.6 years), who underwent surgery with an indication for cardiac myxoma between 2004 and 2016 with a CAG performed preoperatively. All CAGs were evaluated in a blinded manner by a cardiac surgeon and a cardiologist separately. Correlations between the presence and pattern of feeding vessels, presence of an arteriocavity fistula (ACF), coronary arterial dominance, size of mass and clinical presentations were analysed. RESULTS Coronary artery disease defined as >50% obstructive lesions was detected in 10 patients (21.7%). The tumour diameter was found to be significantly higher in patients who had an ACF and a dual-feeding artery (P = 0.049 and P = 0.0001, respectively). Additionally, there was a significant relationship between the presence of dual-feeding vessels and ACF (P = 0.014). ROC analysis revealed a cut-off point of 27 mm in diameter based on the presence of an ACF and a dual-feeding artery. In cases with a diameter of 27 mm or above, the risk of existence of an ACF was 4.68-fold greater, with a confidence interval of 95%, and a dual-feeding pattern was seen in all of them. CONCLUSIONS This study suggests that preoperative CAG can be considered to detect feeding vessels that may lead to a steal phenomenon, which may alter the management in patients with myxoma greater than 27 mm in diameter.
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Affiliation(s)
- Ahmet Yavuz Balci
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Murat Sargin
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Serdar Akansel
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Sennur Ünal Dayi
- Department of Cardiology, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Hüseyin Kuplay
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Müge Evren Mete
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Gökçen Orhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
| | - Serap Aykut Aka
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Hospital, Istanbul, Turkey
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9
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Colin GC, Gerber BL, Amzulescu M, Bogaert J. Cardiac myxoma: a contemporary multimodality imaging review. Int J Cardiovasc Imaging 2018; 34:1789-1808. [DOI: 10.1007/s10554-018-1396-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022]
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10
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Subash S, Thimmarayappa A, Patel GP, Dhananjaya M, Gopal D, Manjunatha N. A Rare Case of Left Atrial Myxoma Vascularity Causing Acquired Coronary Cameral Fistula: Role of Transesophageal Echocardiography. Heart Views 2018; 19:12-15. [PMID: 29876025 PMCID: PMC5965008 DOI: 10.4103/heartviews.heartviews_79_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Left atrial myxoma is the common benign tumor of heart. Coronary arteries may supply these tumor. Considering the vascular nature of the tumor, acquired coronary cameral fistula(CCF) can be a possibility postexcision of the left atrial myxoma. Here, we discuss a case of 53-year-old female patient, who developed acquired CCF, following excision of the tumor and the role of transesophageal echocardiography intraoperatively in diagnosis.
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Affiliation(s)
- S Subash
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Ashwini Thimmarayappa
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Guru P Patel
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Manasa Dhananjaya
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Divya Gopal
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - N Manjunatha
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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11
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Marney L, Saxena P, Yadav S, Kuma L, Anand D. Myocardial ischaemia as a presentation in a neovascularized left atrial myxoma: an unusual finding. ANZ J Surg 2016; 88:E749-E750. [PMID: 27572853 DOI: 10.1111/ans.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 06/12/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Lucy Marney
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Leslie Kuma
- Department of Pathology, The Townsville Hospital, Townsville, Queensland, Australia
| | - Dharmesh Anand
- James Cook University, Townsville, Queensland, Australia.,Department of Cardiology, The Townsville Hospital, Townsville, Queensland, Australia
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Silva M, Carneiro M, Nunes J, da Silva A, de Sousa M. Systematic Review and Meta-analysis of Prevalence of Coronary Artery Disease in Adult Patients with Cardiac Myxomas. F1000Res 2015; 4:194. [PMID: 28620449 PMCID: PMC5461895 DOI: 10.12688/f1000research.6641.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Studies have reported varied prevalence estimates of coronary artery disease (CAD) in cardiac myxoma patients. We performed a systematic review and meta-analysis of observational studies to summarize the point prevalence of CAD in adults with cardiac myxomas. Methods and Results: Two independent investigators searched MEDLINE and LILACS databases using the terms " Myxoma", " Coronary Angiography" and " Coronary Disease" from inception through December 2014 for all relevant studies. We included 6 observational studies. Publication bias was evaluated through Egger's test and Trim and Fill method. A pooled estimate of CAD prevalence with corresponding 95% confidence interval (CI) was calculated based on a random-effects model. The pooled CAD prevalence in adult cardiac myxoma patients was 20.7% with low heterogeneity (I 2 = 14.86%). Conclusions: It is a matter of debate if preoperative coronary angiography must be done as a routine procedure. Although coronary disease and angiographically detectable neovascularity can alter surgical management, more studies are needed to evaluate this question.
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Affiliation(s)
- Matheus Silva
- Inteventional Cardiology Department, Hospital Universitário Ciências Médicas, Belo Horizonte, 30140-073, Brazil
| | - Matheus Carneiro
- Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil
| | - Júlio Nunes
- Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil
| | - Antônio da Silva
- Inteventional Cardiology Department, Hospital São José do Avaí, Itaperuna, 28300-000, Brazil
| | - Marcos de Sousa
- Post Graduation Program in Adult Health Sciences and Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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13
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Suh J, Lee H, Her K, Koh ES. Neovascularization and associated fistula formation in a left atrial myxoma: evaluation with multidetector computed tomography. Can J Cardiol 2014; 30:1250.e9-1250.e11. [PMID: 25108497 DOI: 10.1016/j.cjca.2014.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 11/18/2022] Open
Abstract
Although angiographically detectable neovascularity is being reported with increasing frequency in patients with cardiac myxoma, associated coronary fistula to the cardiac chamber has not been described. We report a 62-year-old woman in whom cardiac computed tomography (CT) enabled the noninvasive diagnosis of a left atrial myxoma with neovascularization arising from the left circumflex artery and the formation of an unusual fistula into the left atrial cavity, with concomitant evaluation of the coronary arteries. Careful suture ligation of a supplying coronary branch in the atrial septum was performed during tumor excision to prevent the development of intra-atrial steal.
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Affiliation(s)
- Jon Suh
- Department of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea.
| | - Keun Her
- Department of Cardiovascular Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Eun Suk Koh
- Department of Pathology, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
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14
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Shabestari MM, Fazlinezhad A, Moravvej Z, Tashnizi MA, Azari A, Bigdelu L. A case of left atrial myxoma with unusual tumor vascularity. Asian Cardiovasc Thorac Ann 2014; 23:458-60. [PMID: 24887916 DOI: 10.1177/0218492313513776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 69-year-old woman presented with a 2-week history of chest pain and mitral and aortic valve replacement 15 and 5 years earlier. Transthoracic echocardiography revealed a well-seated monoleaflet mitral valve and a bileaflet aortic valve with normal function. Cardiac catheterization showed 3-vessel coronary artery disease and an abnormal cluster of new vessels derived from the left atrial circumflex and posterior ventricle branches. Two- and 3-dimensional transesophageal echocardiography identified a semi-mobile oval left atrial mass with multiple internal cystic spaces, attached to the fossa ovalis region in the interatrial septum. The mass was resected. The pathological diagnosis was atrial myxoma.
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Affiliation(s)
- Mahmoud Mohammadzadeh Shabestari
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsoon Fazlinezhad
- Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Cardiovascular Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Moravvej
- Cardiovascular Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Students' Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Abbasi Tashnizi
- Department of Cardiac Surgery, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Azari
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Cardiovascular Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Department of Cardiac Surgery, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Bigdelu
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Cardiovascular Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Akhundova A, Samedov F, Cincin A, Tigen K, Ispir S, Ahiskali AR, Sari I. Giant left atrial myxoma with dual coronary supply presenting with recurrent stroke. Herz 2013; 40:318-20. [PMID: 24189780 DOI: 10.1007/s00059-013-3999-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022]
Affiliation(s)
- A Akhundova
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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16
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Omar HR. The value of coronary angiography in the work-up of atrial myxomas. Herz 2013; 40:442-6. [PMID: 24173374 DOI: 10.1007/s00059-013-3930-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/02/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022]
Abstract
Atrial myxomas are the most common primary cardiac tumors. They are highly vascular with evidence of neovascularization and a characteristic"tumor blush" in approximately half of the cases. Although the visualization of feeding vessels has several clinical and therapeutic implications, there is still no consensus on the indication of preoperative coronary angiography to assess tumor vascularity except in patients with angina or those older than 40 years to rule out coronary artery disease. Herein, I present a case of an incidentally discovered right atrial mass receiving vascular supply from the right coronary artery. The mass was successfully excised and the diagnosis of cardiac myxoma was confirmed via histopathology. A review of the value of coronary angiography in detecting myxoma neovascularization is provided, which suggests that it can offer additional valuable information that can alter the surgical approach and therefore may be considered prior to myxoma resection.
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Affiliation(s)
- H R Omar
- Internal Medicine Department, Mercy Hospital and Medical Center, 2525 South Michigan Avenue, 60616, Chicago, Illinois, USA,
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17
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Wang X, Ren W, Yang J. Neovascularized Myxoma-Causing Abnormal Blood Flow in the Left Atrium Diagnosed by Transesophageal Echocardiography. Echocardiography 2012; 30:E10-2. [PMID: 23002715 DOI: 10.1111/j.1540-8175.2012.01822.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Xiaobing Wang
- Echo Lab; The First Hospital; China Medical University; Shenyang; China
| | - Weidong Ren
- Department of Ultrasonography; Shengjing Hospital; China Medical University; Shenyang; China
| | - Jun Yang
- Echo Lab; The First Hospital; China Medical University; Shenyang; China
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18
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Bayramoğlu Z, Caynak B, Oral K, Erdim R, Teyyareci Y, Akpınar B. Left atrial myxoma with neovascularization presenting as a sick sinus syndrome. Heart Surg Forum 2012; 15:E200-3. [PMID: 22917824 DOI: 10.1532/hsf98.20111180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myxoma is benign tumor of the heart. It is mostly located in the left atrium and revascularized by the left and right coronary artery in 30% to 40% of cases. Symptoms of these neovascularized cardiac myxomas are typically quite variable, from obstruction of mitral valve to coronary embolism resulting in acute myocardial infarction. In this case, left atrial myxoma that is revascularized by nodal branches of the right coronary artery presented as a sick sinus syndrome, which is rare in literature.
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Affiliation(s)
- Zehra Bayramoğlu
- Department of Cardiovascular Surgery, Florence Nightingale Hospital, Istanbul, Turkey.
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19
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Hari P, Mohamad T, Kondur A, Jahania SM, Afonso L. Incremental value of contrast echocardiography in the diagnosis of atrial myxoma. Echocardiography 2010; 27:E46-9. [PMID: 20374266 DOI: 10.1111/j.1540-8175.2009.01128.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intracardiac myxomas have traditionally been divided into solid ovoid and soft papillary types based on a morphological appearance. Papillary myxomas given their friable nature are far more likely to cause embolic phenomenon and present with neurological symptoms, making it necessary to discriminate between these tumor subtypes. Papillary myxomas have also been demonstrated to be significantly less vascular than their ovoid counterparts in previous angiographic studies. We describe here for the first time, the application of transesophageal real time myocardial contrast echocardiography in a case of atrial papillary myxoma to assess tumor vascularity. (Echocardiography 2010;27:E46-E49).
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Affiliation(s)
- Pawan Hari
- Division of Internal Medicine, Wayne State University, Detroit, MI 48201, USA
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20
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Kim YK, Yong HS, Kang EY, Woo OH. Left atrial myxoma with neovascularization: detected on cardiac computed tomography angiography. Int J Cardiovasc Imaging 2009; 25 Suppl 1:95-8. [DOI: 10.1007/s10554-008-9416-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
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21
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Stainback RF, Hamirani YS, Cooley DA, Buja LM. Tumors of the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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22
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Abstract
BACKGROUND Myxoma usually presents with nonspecific symptoms. Preoperative coronary angiography is presently only considered if patients are at increased risk of coronary artery disease (CAD). The angiographic patterns of cardiac myxoma have not been fully described. HYPOTHESIS The aim of our study was to investigate coronary angiograms as well as patterns of tumor vascularity in patients with cardiac myxoma. METHODS From January 1990 to December 2003, 33 patients with cardiac myxoma, who had received surgical resection at our hospital, were enrolled; of these, 9 patients underwent preoperative coronary angiography. The severity and extent of coronary artery stenosis, as well as tumor angiographic patterns, were analyzed. Coronary artery disease is defined as a > 50% stenosis in diameter at any segment of the coronary artery viewed by two orthogonal views on cineangiogram. RESULTS Four (44.4%) patients showed concomitant CAD. The presence of coronary risk factors was not different between patients with and without CAD. Contrast media-enhanced tumor vasculature was found in five (55.6%) patients. Four (80%) patients had multiple feeding arteries. There was the characteristic "sea anemone" appearance of the tumor vasculature composed of (1) basal vascular network, (2) vessel stem, (3) backbone branches, and (4) dye brushes. These findings were characteristic of cardiac myxoma. CONCLUSION Coronary angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma. Familiarity with the "sea-anemone" angiographic findings may help in the diagnosis of cardiac myxoma.
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Affiliation(s)
- Chun‐Yao Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang‐Ming University, Taipei, Taiwan
| | - Wen‐Chung Yu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang‐Ming University, Taipei, Taiwan
| | - Kuan‐Chun Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing‐Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang‐Ming University, Taipei, Taiwan
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23
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Janas R, Jutley RS, Fenton P, Sarkar P. Should we perform preoperative coronary angiography in all cases of atrial myxomas? Catheter Cardiovasc Interv 2006; 67:379-83. [PMID: 16489561 DOI: 10.1002/ccd.20643] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The prevalence of coronary disease is high in patients with atrial myxomas yet routine angiography is not performed. Moreover, some tumors have angiographically detectable neovascularity, which can alter surgical planning. We report two cases that support our recommendation for performing coronary angiography in all cases diagnosed with cardiac myxomas.
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Affiliation(s)
- Robert Janas
- Department of Cardiac Surgery, Chesterman Unit, Northern General Hospital, Sheffield, United Kingdom.
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24
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Kejriwal NK, Tan J, Ullal RR, Alvarez JM. Atrial myxoma with coexistent coronary artery disease: a report of two cases. Heart Lung Circ 2005; 12:108-11. [PMID: 16352117 DOI: 10.1046/j.1444-2892.2003.00195.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The age at presentation and the symptoms of atrial myxomas and coronary artery disease can be similar. At times, the two lesions coexist. Operative strategy needs to be carefully planned when combined surgical treatment is contemplated. In the present paper, two cases of concomitant atrial myxoma and atherosclerotic coronary artery disease are reported. The first patient had a left atrial myxoma with triple-vessel coronary artery disease. The other had a right atrial myxoma and needed two bypass grafts. Both patients had a satisfactory outcome.
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Affiliation(s)
- Nand K Kejriwal
- Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand
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25
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Yazici M, Norgaz T, Akdemir R, Albayrak S. Asymptomatic giant left atrial myxoma supplied from right coronary artery in a 65-year-old woman. Int J Cardiol 2005; 101:495-6. [PMID: 15907421 DOI: 10.1016/j.ijcard.2004.01.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2003] [Revised: 12/25/2003] [Accepted: 01/08/2004] [Indexed: 11/19/2022]
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26
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Dübel HP, Knebel F, Gliech V, Konertz W, Rutsch W, Baumann G, Borges AC. Atypical vessels as an early sign of intracardiac myxoma? Cardiovasc Ultrasound 2004; 2:13. [PMID: 15310408 PMCID: PMC514718 DOI: 10.1186/1476-7120-2-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 08/13/2004] [Indexed: 01/12/2023] Open
Abstract
We report on a woman with previously unknown left atrial myxoma, who underwent percutaneous coronary intervention. 45 months after the initial coronary angiography, echocardiography demonstrated a large atrial myxoma, which was not seen echocardiographically before. The retrospective analysis of the pre-intervention coronary angiography revealed atypical vessels in the atrial septum, which are interpreted as early signs of myxoma.
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Affiliation(s)
- Hans-Peter Dübel
- Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, University medicine Berlin, Germany
| | - Fabian Knebel
- Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, University medicine Berlin, Germany
| | - Volker Gliech
- Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, University medicine Berlin, Germany
| | - Wolfgang Konertz
- Director of the Clinic of Cardiovascular Surgery, Charité Campus Mitte, University Medicine Berlin, Germany
| | - Wolfgang Rutsch
- Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, University medicine Berlin, Germany
| | - Gert Baumann
- Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, University medicine Berlin, Germany
| | - Adrian Constantin Borges
- Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, University medicine Berlin, Germany
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27
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Youn HJ, Jung SE, Chung WS, Choi MG, Lee KY, Chung KW, Hong SJ, Sun HS. Obstruction of right ventricular outflow tract by extended cardiac metastasis from esophageal cancer. J Am Soc Echocardiogr 2002; 15:1541-4. [PMID: 12464926 DOI: 10.1067/mje.2002.128119] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a patient in whom there was right ventricular outflow tract obstruction by extended metastasis from esophageal cancer. A 65-year-old man was admitted to the hospital for evaluation of recent onset of weight loss and heart murmur. Esophagogram and endoscopy showed a 10-cm, ulcerative, infiltrative esophageal cancer. This esophageal cancer was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography, magnetic resonance imaging, coronary angiography, and endomyocardial biopsy were performed. The magnetic resonance imaging, echocardiography, and right ventriculography revealed a 7-cm lobulated mass extending to the right ventricular outflow tract, right ventricle, septum, and anterior wall of the left ventricle. Interestingly, the feeding vessels of the tumor were identified by echocardiography and coronary angiography. Histologically, the cardiac tumor was proven to be have the same pathologic findings as esophageal cancer, compatible with carcinomatous metastasis.
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Affiliation(s)
- Ho-Joong Youn
- Division of Cardiology, College of Medicine, The Catholic University of Korea, Seoul.
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28
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Batur MK, Yildirir A, Kabakci G, Aksöyek S. A huge mitral valve tumor and its vascularity--a case report. Angiology 2001; 52:77-81. [PMID: 11205937 DOI: 10.1177/000331970105200112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary cardiac tumors of the mitral valve are extremely rare; however, they present a major risk of embolization. Therefore, prompt diagnosis and urgent treatment is obligatory. The authors report the case of a 60-year-old man with a huge mitral valve mass and its vascularity, which was diagnosed by transthoracic echocardiography and selective coronary arteriography. Our patient's mitral valve tumor had a size of 5.9 x 2.9 cm, which was the largest size reported up to this time in this location. The patient died from a major cerebrovascular event before surgical excision could be performed.
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Affiliation(s)
- M K Batur
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
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29
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Horn KD, Becich MJ, Rhee RY, Pham SM. Left atrial myxoma with embolization presenting as an acute infrarenal aortic occlusion. J Vasc Surg 1997; 26:341-5. [PMID: 9279325 DOI: 10.1016/s0741-5214(97)70199-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present the case of a 42-year-old woman who had acute total infrarenal aortic occlusion resulting from embolic implantation from a left atrial myxoma. We propose that the small aortic aneurysm that was discovered and repaired in this case may be a direct result of invasion and destruction of the aortic elastic laminae by implanted myxomatous tissue originating in the primary atrial tumor. This behavior has been noted in small vessels of the cerebrum and upper extremities with this lesion, but no prior reports of this occurrence in the aorta has been noted after extensive review of the literature.
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Affiliation(s)
- K D Horn
- Department of Pathology, University of Pittsburgh Medical Center, PA 15213-2582, USA
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