1
|
Singh A, Mukati R, Bansal M. The Utility of Routine Intraoperative Transesophageal Echocardiography During Coronary Artery Bypass Graft Surgery: An Unexpected Reminder. Ann Card Anaesth 2024; 27:282-284. [PMID: 38963371 PMCID: PMC11315252 DOI: 10.4103/aca.aca_213_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/21/2024] [Accepted: 01/29/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Ajmer Singh
- Department of Cardiac Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Ravina Mukati
- Department of Clinical and Preventive Cardiology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Manish Bansal
- Department of Cardiac Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| |
Collapse
|
2
|
Maddali MM, Chauhan A, Kandachar PS, Al-Farqani A, Al Kindi HN. A Newly Detected Left Ventricular Mass Following A Complex Intracardiac Repair. Sultan Qaboos Univ Med J 2023; 23:59-62. [PMID: 38161754 PMCID: PMC10754302 DOI: 10.18295/squmj.12.2023.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/14/2023] [Accepted: 04/19/2023] [Indexed: 01/03/2024] Open
Abstract
Appearance of unexpected masses in the chambers of the heart during cardiac surgery can be intriguing. We report the case of a mass in the left ventricle that appeared at the time of separation from cardiopulmonary bypass in a child after a complex intracardiac repair. The child presented for surgery to a tertiary care hospital in Muscat, Oman, in 2022. Prior to the surgical repair the mass was not appreciated by echocardiography. An intraventricular baffle was used to divert left ventricular blood flow towards the outflow tract, after which an intraventricular "mass" was observed. Intraoperative transoesophageal echocardiography identified the mass as a portion of the interventricular septum that was located between the inlet and outlet ventricular septal defects.
Collapse
Affiliation(s)
| | | | | | - Abdulla Al-Farqani
- Pediatric Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | | |
Collapse
|
3
|
Cullom C, Frank S, McCabe MD. Bilateral Atrial Myxoma With Mechanical Disruption of the Mitral Valvular Apparatus. J Cardiothorac Vasc Anesth 2023; 37:2032-2039. [PMID: 37357034 DOI: 10.1053/j.jvca.2023.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Christopher Cullom
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA.
| | - Stephanie Frank
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
| | - Melissa D McCabe
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
| |
Collapse
|
4
|
Zubair MH, Jain A. Unraveling the Enigmatic World of Cardiac Tumor Imaging. J Cardiothorac Vasc Anesth 2023; 37:2157-2158. [PMID: 37394387 DOI: 10.1053/j.jvca.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Affiliation(s)
- M Haseeb Zubair
- Department of Anesthesiology and Perioperative Medicine, Marshfield Clinic Medical Center, Marshfield, WI.
| | - Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia Augusta University, Augusta, GA
| |
Collapse
|
5
|
Reiter T, Demirbas S, Schmalzing M, Voelker W, Bauer WR, Güder G. CMR detects extensive intracavitary thrombi as solitary clinical presentation of Antiphospholipid Syndrome: A case report. Clin Case Rep 2022; 10:e6568. [PMID: 36397843 PMCID: PMC9664543 DOI: 10.1002/ccr3.6568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Intracavitary thrombi are an important differential diagnosis of cardiac masses. Cardiac magnetic resonance imaging (CMR) allows their non-invasive characterization. This case highlights extensive cardiac thrombi detected by CMR as solitary presentation of antiphospholipid syndrome.
Collapse
Affiliation(s)
- Theresa Reiter
- Department for Internal Medicine I, CardiologyUniversity Hospital WuerzburgWuerzburgGermany
| | - Senem Demirbas
- Department for Internal Medicine I, CardiologyUniversity Hospital WuerzburgWuerzburgGermany
| | - Marc Schmalzing
- Department for Internal Medicine II, RheumatologyUniversity Hospital WuerzburgWuerzburgGermany
| | - Wolfram Voelker
- Department for Internal Medicine I, CardiologyUniversity Hospital WuerzburgWuerzburgGermany
| | - Wolfgang R. Bauer
- Department for Internal Medicine I, CardiologyUniversity Hospital WuerzburgWuerzburgGermany
| | - Gülmisal Güder
- Department for Internal Medicine I, CardiologyUniversity Hospital WuerzburgWuerzburgGermany
- Comprehensive Heart Failure Center WuerzburgUniversity Hospital WuerzburgWuerzburgGermany
| |
Collapse
|
6
|
Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
Collapse
|
7
|
Jain M, Harjpal P, Yadav V, Kovela RK, Vardhan V. Early Rehabilitation for Cerebellar Complications Following Left Atrial Myxoma Excision: A Stitch in Time Saves Nine. Cureus 2022; 14:e28773. [PMID: 36225469 PMCID: PMC9531849 DOI: 10.7759/cureus.28773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
Abstract
The most known of all primary cardiac tumors is myxoma, which is most usually detected in the left atrium. As there are no physical signs or symptoms, a diagnosis is rarely made purely based on clinical evidence. Our study aims to investigate the case of post-operative left atrial myxoma with cerebellar signs. A 50-year-old woman complained of dizziness and syncope, which caused her to collapse on the floor early in the morning. Myxoma in the left atrium and mitral valve regurgitation was discovered after prompt medical assistance. She was recommended for surgery to excise the left atrial myxoma and mitral valve repair. Post the surgery, she developed breathing difficulties and cerebellar signs for which she was referred for physiotherapy. She underwent two weeks of tailor-made inpatient rehabilitation. This case study intends to emphasize the importance of early diagnosis, treatment, and, most importantly, rehabilitation to return the patient to her functional state. A structured exercise regimen assists the patient while also reducing post-surgery problems. Timely monitoring and treatment are projected to improve outcomes in patients treated with a multidisciplinary approach.
Collapse
|
8
|
Redzek A, Preveden A, Kaloci SR, Samardzija G, Preveden M, Golubovic M, Velicki L. Unusual non-valvular left ventricular endocarditis presenting as multiple brain embolism. Acta Clin Belg 2022; 77:142-146. [PMID: 32602786 DOI: 10.1080/17843286.2020.1789273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Masses inside the heart can cause serious and life-threatening effects to the cardiovascular system, mainly because of hemodynamic obstruction of the blood flow, either in the heart cavities themselves or remotely due to embolization. In this paper, we report a case of left ventricular tumor mass which presented with neurological symptoms due to multiple brain embolism. CASE REPORT A 35-year-old female patient presented with right hemiparesis and dysarthria. Seven days prior to admission she had elevated body temperature and started taking antibiotics. Inflammatory markers were not elevated, and blood cultures were negative. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed multiple acute ischemic lesions. Echocardiography showed the presence of a lobular mass inside the left ventricle, which was attached to the basal segment of the lateral left ventricular wall. Based on the laboratory results and additional heart imaging (CT and MRI) the mass was primarily suspected to be a tumor. It was surgically removed. Microscopic analysis of the removed tissue revealed a non-specific endocardial inflammation with formed fresh fibrin thrombi on the surface. During the postoperative recovery intense physical rehabilitation was being performed, so the initial neurological deficit was completely withdrawn. CONCLUSION Intracardiac masses can cause serious and potentially fatal complications that often present with dramatic clinical symptoms. Despite the comprehensive clinical, laboratory, and imaging investigations, intracardiac masses can be hard to distinguish until the definite microscopic analysis. However, with the right approach and multidisciplinary collaboration, they can be successfully managed.
Collapse
Affiliation(s)
- Aleksandar Redzek
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Andrej Preveden
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Svetlana Ruzicka Kaloci
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Golub Samardzija
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Mihaela Preveden
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Miodrag Golubovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| |
Collapse
|
9
|
Kong LY, Cui XZ, Xiang W, Chen LL, Li L, Liu F. Case Report: Two Myxomas of Different Echodensities on Transthoracic Echocardiography in One Patient. Front Cardiovasc Med 2022; 8:770228. [PMID: 35127850 PMCID: PMC8810647 DOI: 10.3389/fcvm.2021.770228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
We report a rare case of coincidental left atrial and right ventricular myxomas manifesting as masses with different echodensities on transthoracic echocardiography. This patient had a history of left atrial myxoma, left intra-left internal carotid artery myxoma, and facial cutaneous myxoma 3 years prior to admission. A Carney complex was suspected, and the patient subsequently tested positive for PRKAR1A mutations. The patient was followed up regularly by a biannual echocardiography, which was free from abnormalities until the date of admission. A repeat transthoracic echocardiography revealed a massive left atrial mass of solid echodensity, and a minute hypoechoic entity in the right ventricular outflow tract. Both masses were confirmed for existence by an enhanced cardiac CT. Chest CT also revealed multiple pulmonary emboli. Successful surgical repair was performed revealing that both masses were hemorrhagic nipple-like lesions and that the pulmonary emboli were myxomatous in nature. Postoperative recovery was uneventful. Postoperative echocardiography showed a clear heart chamber, and the 1-year follow-up showed no abnormalities. Further research is needed to clarify the echocardiographic characteristics of multiple myxomas when they occurred simultaneously in different chambers.
Collapse
Affiliation(s)
- Ling-Yun Kong
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xiao-Zheng Cui
- Department of Cardiovascular Surgery, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Wei Xiang
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Ling-Ling Chen
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Li Li
- Department of Pathology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Fang Liu
- Department of Cardiology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
- *Correspondence: Fang Liu
| |
Collapse
|
10
|
Nakagawa-Kamiya T, Mori M, Ohira M, Iino K, Kawashiri MA, Takemura H, Takamura M. Intimal Sarcoma: An Extremely Rare Case of a Left Atrial Tumor with Partial Obstruction of the Mitral Orifice. ACTA ACUST UNITED AC 2021; 5:93-96. [PMID: 33912776 PMCID: PMC8071820 DOI: 10.1016/j.case.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Primary malignant cardiac tumors are very rare. This is the first case report of intimal sarcoma of left atrial origin. Echocardiographic diagnosis of malignant cardiac tumor is critical but challenging. The authors outline the differentiation of primary malignant cardiac tumors.
Collapse
Affiliation(s)
- Tamami Nakagawa-Kamiya
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Mika Mori
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Miho Ohira
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenji Iino
- Department of Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| |
Collapse
|
11
|
Murukendiran GJ, Babu S, Gadhinglajkar SV, Sreedhar R, Palaniswamy N, Pillai V. Extracardiac Intrapericardial Mass Impersonating as Left Atrial Mass: Echocardiographic Perspectives. A A Pract 2021; 15:e01359. [PMID: 33405398 DOI: 10.1213/xaa.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Extracardiac intrapericardial masses arising posterior to left atrium (LA) often mimic an intracardiac LA mass on echocardiography. Although transthoracic echocardiography (TTE) is the primary screening tool to detect any cardiac mass, transesophageal echocardiography (TEE) is proven superior to TTE in delineating the size, morphology, and exact site of origin of LA masses. We report a case, where the preoperative TTE diagnosed an LA mass which was later confirmed to be an extracardiac intrapericardial mass by cardiac magnetic resonance imaging and intraoperative TEE. The mass was compressing the LA, and the timely diagnosis avoided the opening of the LA for mass excision.
Collapse
Affiliation(s)
| | - Saravana Babu
- From the Division of Cardiothoracic and Vascular Anesthesia
| | | | - Rupa Sreedhar
- From the Division of Cardiothoracic and Vascular Anesthesia
| | | | - Vivek Pillai
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
12
|
Koseoglu C, Kurmus O. Association between Mean Platelet Volume-to-Lymphocyte Ratio and the Presence of Apical Mural Thrombus in Post-Myocardial Infarction Patients. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
13
|
Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, Westwood M, Ghosh AK, Guha A. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:293-311. [PMID: 34396236 PMCID: PMC8352246 DOI: 10.1016/j.jaccao.2020.05.009] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses. Cardiac tumors are rare and should be considered as part of the differential diagnosis of any space-occupying mass noted on cardiovascular and/or thoracic imaging modalities. It may be possible to get close to a diagnosis without biopsy using a structured imaging approach. The prognosis and treatment of each tumor is different, although early diagnosis is usually associated with a better outcome.
Collapse
Affiliation(s)
- Sara Tyebally
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Daniel Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Abdallah Mughrabi
- Jordan University of Science and Technology, Al Ramtha, Irbid, Jordan
| | - Zeeshan Hussain
- Division of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Charlotte Manisty
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Mark Westwood
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
14
|
L'Angiocola PD, Donati R. Cardiac Masses in Echocardiography: A Pragmatic Review. J Cardiovasc Echogr 2020; 30:5-14. [PMID: 32766100 PMCID: PMC7307625 DOI: 10.4103/jcecho.jcecho_2_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
Transthoracic echocardiography is a useful diagnostic technique for the identification of intracardiac and extracardiac masses, which can evaluate morphologic properties of the masses such as their location, attachment, shape, size, mobility, and possible hemodynamic-related implications. Apart from physiological variants and structural normal mimickers, echocardiography can detect principal intracardiac masses such as neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic lesions. Moreover, transesophageal echocardiography can provide further details and provide higher accuracy in case a deeper examination of the mass is needed. This review will focus on the systematic evaluation of intra-/extracardiac masses including epidemiology and morphological and echocardiographic features, providing practical and technical tips to health-care professionals to achieve correct identification of the masses. General data on cardiac masses were extracted via PubMed/MEDLINE search engine from indexed reviews, original studies, and clinical case reports. The echocardiographic features of cardiac masses were reviewed according to the most relevant international cardiology and echocardiography scientific societies' position statements.
Collapse
Affiliation(s)
| | - Roberto Donati
- Department of Cardiology, Giovan Battista Grassi Hospital, Rome, Italy
| |
Collapse
|
15
|
Left Ventricular Cavity Obliteration From Eosinophilic Myocarditis in a Patient With Classic Hodgkin Lymphoma. JACC Case Rep 2020; 2:210-215. [PMID: 34317206 PMCID: PMC8298684 DOI: 10.1016/j.jaccas.2019.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022]
Abstract
A 43-year-old female with a history of hypereosinophilia developed acutely decompensated heart failure. Prototypical features of eosinophilic myocarditis, including a distinctive left ventricular mass and severe mitral regurgitation, were identified on a transthoracic echocardiogram. The patient's eosinophilia was subsequently attributed to Hodgkin lymphoma, and chemotherapy resolved her heart failure symptoms. (Level of Difficulty: Intermediate.).
Collapse
|
16
|
Parwani P, Co M, Ramesh T, Akhter N, Iliescu C, Palaskas N, Kim P, Gladish G, Stojanovska J, Abramov D, Lopez-Mattei J. Differentiation of Cardiac Masses by Cardiac Magnetic Resonance Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-019-9522-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
17
|
Abstract
Cardiac myxoma is the most common type of primary cardiac neoplasm. Over 70% of all cardiac myxomas originate from the left atrium (LA) and 18% from the right atrium (RA). Most myxomas present with constitutional, embolic, and obstructive manifestations. We are presenting a case where a part of myxoma got embolized intra-operatively. Using trans-oesophageal echocardiography, we were able to diagnose and image the transit of the tumor from the left ventricle to the left atrium. We removed the embolized tumor from the left atrium and prevented a dreaded complication like stroke, mesenteric ischemia, renal infarct or limb ischemia, which would have resulted in increased morbidity or mortality of the patient.
Collapse
Affiliation(s)
- U S Dinesh Kumar
- Department of Cardiac Thoracic and Vascular Anesthesia, JSS Superspeciality Hospital and Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Murugesh Wali
- Department of Cardiac Thoracic and Vascular Anesthesia, JSS Superspeciality Hospital and Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Shyam Prasad Shetty
- Department of Cardio-Thoracic Surgery, JSS Superspeciality Hospital and Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - K R Sujay
- Department of Cardio-Thoracic Surgery, JSS Superspeciality Hospital and Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| |
Collapse
|
18
|
Barberato SH, Romano MMD, Beck ALDS, Rodrigues ACT, Almeida ALCD, Assunção BMBL, Gripp EDA, Guimarães Filho FV, Abensur H, Castillo JMD, Miglioranza MH, Vieira MLC, Barros MVLD, Nunes MDCP, Otto MEB, Hortegal RDA, Barretto RBDM, Campos TH, Siqueira VND, Morhy SS. Position Statement on Indications of Echocardiography in Adults - 2019. Arq Bras Cardiol 2019; 113:135-181. [PMID: 31411301 PMCID: PMC6684182 DOI: 10.5935/abc.20190129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
| | - Minna Moreira Dias Romano
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP - Brazil
| | - Adenalva Lima de Souza Beck
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brazil.,Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil
| | - Ana Clara Tude Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.,DASA, São Paulo, SP - Brazil
| | | | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Haertel Miglioranza
- Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil.,Instituto de Cardiologia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Márcio Vinicius Lins de Barros
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG - Brazil.,Rede Materdei de Saúde, Belo Horizonte, MG - Brazil.,Hospital Vera Cruz, Belo Horizonte, MG - Brazil
| | | | | | | | | | - Thais Harada Campos
- Diagnoson-Fleury, Salvador, BA - Brazil.,Hospital Ana Nery, Salvador, BA - Brazil
| | | | | |
Collapse
|
19
|
Doshi A, Shah D, Gupta S, Panday D, Farji-Cisneros A, Ramsaran E, Bojar R. A Rare Case of an Ectopic Liver Presenting as Right Atrial Mass. Case Rep Cardiol 2019; 2019:4103827. [PMID: 31223505 PMCID: PMC6541936 DOI: 10.1155/2019/4103827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022] Open
Abstract
Ectopic liver tissue is commonly observed in the abdominal cavity in adjacent organs. Extension of hepatic tissue into the intrathoracic cavity is rarely reported. We present the case of a 46-year-old woman with a 2.1 × 1.8 cm mass confirmed by transesophageal echocardiogram to be at the right atrial and inferior vena cava junction that was initially thought to be a myxoma which prompted surgical excision but subsequently identified as ectopic liver by histology.
Collapse
Affiliation(s)
- Adhirath Doshi
- Division of Cardiology, St. Vincent Hospital, Worcester, MA, USA
| | - Dhaval Shah
- Division of Cardiology, St. Vincent Hospital, Worcester, MA, USA
| | - Shradha Gupta
- Department of Internal Medicine, St. Vincent Hospital, Worcester, MA, USA
| | - Deepika Panday
- Department of Internal Medicine, St. Vincent Hospital, Worcester, MA, USA
| | | | - Eddison Ramsaran
- Department of Cardiology, Reliant Medical Group, Worcester, MA, USA
| | - Robert Bojar
- Division of Cardiothoracic Surgery, St. Vincent Hospital, Worcester, MA, USA
| |
Collapse
|
20
|
Kavakli AS, Kavrut Ozturk N. [Determination of residual mass in left ventricle by intraoperative transesophageal echocardiography after a giant and floating left atrial myxoma resection]. Rev Bras Anestesiol 2017; 68:524-527. [PMID: 29274676 DOI: 10.1016/j.bjan.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
Abstract
Atrial myxoma is a benign tumor of the heart that occurs primarily in the left atrium. Floating or large left atrial myxomas frequently cause functional mitral stenosis, may also affect mitral valve structure and flow, and lead to mitral regurgitation. Systemic embolization occurs in around 30% of cases either from tumor fragmentation or complete tumor detachment hence it should be removed as soon as it is detected. Intraoperative transesophageal echocardiography has a vital importance in the surgery. After resection of myxoma, intraoperative transesophageal echocardiography must be performed to rule out residual mass. The case here reported is of a 48-year old female, who presented with giant and floating left atrial myxoma. Residue mass was detected with intraoperative transesophageal echocardiography in the left ventricle after the resection of myxoma. Subsequently, the residue mass was successfully removed. Complete resection must be required to prevent possible complications such as recurrence, embolization in atrial myxomas. Transesophageal echocardiography performed intraoperatively is vital importance to confirm that the myxoma is completely resected.
Collapse
Affiliation(s)
- Ali Sait Kavakli
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turquia.
| | - Nilgun Kavrut Ozturk
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turquia
| |
Collapse
|
21
|
Dinesh Kumar US, Shetty SP, Sujay KR, Wali M. Left ventricular mass: A tumor or a thrombus diagnostic dilemma. Ann Card Anaesth 2017; 19:728-732. [PMID: 27716707 PMCID: PMC5070336 DOI: 10.4103/0971-9784.191551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Left ventricular (LV) mass is a rare condition, of which the most common is thrombus. Echocardiography is a very useful modality of investigation to evaluate the LV mass. We are reporting a case of LV mass presenting with neurological symptom. The diagnosis of this mass was dilemma as the echocardiographic features were favoring tumor as well as thrombi. Mass (a) measuring 3.8 cm × 1.9 cm attached to the left ventricle apex appeared to be pedunculated tumor and mass (b) measuring 2.4 cm × 1.8 cm attached to the chordae of anterior mitral leaflet resembled a thrombus or an embolized tumor entangled in the chordae. A differential diagnosis for the LV mass is thrombus, tumors such as fibroma, and vegetation. Preoperative detection of a thrombus leads to an alteration in surgical steps. A large and mobile thrombus with or without a hemodynamic alteration is an indication for surgical removal to prevent stroke, myocardial infarction, mesenteric ischemia, renal infarction, gangrene of the limbs, and mortality.
Collapse
Affiliation(s)
- U S Dinesh Kumar
- Department of Cardiac Thoracic and Vascular Anesthesia, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| | - Shyam Prasad Shetty
- Department of Cardio Vascular and Thoracic Surgery, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| | - K R Sujay
- Department of Cardio Vascular and Thoracic Surgery, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| | - Murugesh Wali
- Department of Cardiac Thoracic and Vascular Anesthesia, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| |
Collapse
|
22
|
Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
Collapse
Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| |
Collapse
|
23
|
Mankad R, Herrmann J. Cardiac tumors: echo assessment. Echo Res Pract 2016; 3:R65-R77. [PMID: 27600455 PMCID: PMC5292983 DOI: 10.1530/erp-16-0035] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 12/20/2022] Open
Abstract
Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.
Collapse
Affiliation(s)
- Rekha Mankad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
24
|
Karabag T, M Dogan S, Aydin M, R Sayin M. Giant Left Atrial Myxoma Causing Mitral Valve Obstruction and Concomitant Coronary Artery Disease. Cardiol Res 2011; 2:246-248. [PMID: 28357014 PMCID: PMC5358286 DOI: 10.4021/cr84w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 12/02/2022] Open
Abstract
We describe a 56-year old male patient who presented with congestive heart failure and had undergone echocardiography that showed a mobile, giant left atrial mass which caused obstruction in the left ventricular outflow tract. The patient underwent a coronary angiography before operation that showed severe stenosis in the left anterior descending and circumflex artery. The patient underwent resection of the mass and coronary artery bypass grafting. The pathology of the mass was myxoma and patient had a satisfactory outcome.
Collapse
Affiliation(s)
- Turgut Karabag
- Zonguldak Karaelmas University, Faculty of Medicine, Department of Cardiology, Zonguldak, Turkey
| | - Sait M Dogan
- Zonguldak Karaelmas University, Faculty of Medicine, Department of Cardiology, Zonguldak, Turkey
| | - Mustafa Aydin
- Zonguldak Karaelmas University, Faculty of Medicine, Department of Cardiology, Zonguldak, Turkey
| | - Muhammet R Sayin
- Zonguldak Karaelmas University, Faculty of Medicine, Department of Cardiology, Zonguldak, Turkey
| |
Collapse
|
25
|
Ilhan E, Güvenç TS, Tayyareci G. An undulating giant left ventricular apical thrombus after myocardial infarction. Neth Heart J 2011; 20:292-3. [PMID: 21584801 DOI: 10.1007/s12471-011-0151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- E Ilhan
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Tibbiye Caddesi, Haydarpasa, 34668, Istanbul, Turkey,
| | | | | |
Collapse
|
26
|
Chin JH, Lee EH, Choi DK, Choi IC. A Modification of the Trans-Oesophageal Echocardiography Protocol can Reduce Post-Operative Dysphagia following Cardiac Surgery. J Int Med Res 2011; 39:96-104. [DOI: 10.1177/147323001103900112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Use of intra-operative trans-oesophageal echocardiography (TEE) is an independent risk factor for post-operative dysphagia. This study investigated whether modifying the TEE probe-placement protocol could reduce the incidence of post-operative dysphagia. In group I ( n = 100), the TEE probe was inserted after anaesthetic induction and remained in place until the completion of surgery. In group II ( n = 100), the TEE probe was inserted after anaesthetic induction, the heart was examined, then the probe was removed. The probe was inserted again before weaning from cardiopulmonary bypass and then immediately removed after examination. The incidence of dysphagia was significantly higher in group I than in group II patients (51.1% versus 28.6%). Multivariate regression analysis showed that the length of time that the TEE probe was in the oesophagus was an independent predictor of dysphagia. Modification of the TEE protocol in this way can reduce the incidence of post-operative dysphagia in cardiac surgery patients.
Collapse
Affiliation(s)
- J-H Chin
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - E-H Lee
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D-K Choi
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - I-C Choi
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
27
|
İlhan E, Kul Ş, Güvenç TS, Çanga Y, Soylu Ö. Incidentally Diagnosed Unusual Ascending Aorta Mass. Echocardiography 2010; 28:E34-5. [DOI: 10.1111/j.1540-8175.2010.01272.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
28
|
Left Ventricular Mass: Intraoperative Transesophageal Echocardiography for Evaluation and Management. Anesth Analg 2008; 107:1153-4. [DOI: 10.1213/ane.0b013e3181806681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
29
|
Ha JW, Chung N, Hong YW, Kwak YR, Chang BC, Cho SY. Alteration of surgical management following intraoperative transesophageal echocardiography in a patient with mobile left atrial thrombi embolized during anesthesia. Echocardiography 2003; 20:291-2. [PMID: 12848669 DOI: 10.1046/j.1540-8175.2003.03029.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This report describes alteration of surgical management in a patient with a large free-floating ball thrombus in the left atrium, which was embolized before sternotomy as demonstrated by intraoperative transesophageal echocardiography. Due to new findings observed by intraoperative transesophageal echocardiography, unnecessary sternotomy could be avoided.
Collapse
Affiliation(s)
- Jong-Won Ha
- Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | | | | | | | | | | |
Collapse
|