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Al Zweihary AM. Misattribution of Dyspnea: Unveiling Atrial Myxoma as the True Culprit. Cureus 2024; 16:e58790. [PMID: 38784305 PMCID: PMC11112133 DOI: 10.7759/cureus.58790] [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] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiac myxomas are the most common primary tumors of cardiac neoplasm, predominantly originating within the left atrium (LA). In the present case, a 41-year-old male, identified as a heavy smoker for 15 years, previously diagnosed with chronic obstructive pulmonary disease (COPD) and currently undergoing treatment, presented with a history of dyspnea persisting for one year. Initially, the patient presented to the internal medicine outpatient clinic and was diagnosed with an exacerbation of COPD, but subsequent evaluation revealed the presence of a large mobile pedunculated mass situated in the LA using echocardiography. Subsequently, the mass was surgically excised using a median sternotomy approach. The histopathological examination confirmed cardiac myxoma. This occurrence underscores the significance of considering cardiac myxoma as a plausible differential diagnosis in instances of dyspnea to avert potential complications.
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Affiliation(s)
- Ali M Al Zweihary
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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2
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Ale P, Gurung A, Hargroves D, Omojowolo O. Atrial myxoma: A cause for concern in multiple cerebral infarctions in absence of cardiac symptoms. BMJ Case Rep 2023; 16:e257157. [PMID: 38011961 PMCID: PMC10685979 DOI: 10.1136/bcr-2023-257157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Ischaemic cerebral infarct is the most common neurological manifestation of myxomas. We present a mid-70s man who was brought to the stroke unit with sudden onset right hemiparesis and dysarthria. Although he had risk factors for developing stroke like hypertension, hypercholesterolaemia, history of prostate cancer and new paroxysmal atrial flutter on admission, clinical suspicion and detailed investigations in the absence of cardiac symptoms revealed a 9 cm myxoma causing severe mitral stenosis. He underwent successful surgical resection with good functional recovery. This also highlights the need for thorough clinical examination especially in the absence of cardiac symptoms.
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Affiliation(s)
- Pramol Ale
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
| | - Abinas Gurung
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
| | - David Hargroves
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
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3
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Mendes Franco R, Sousa J, Matos M, Albuquerque L, Azevedo E, Abreu P. Multiple intracranial aneurysms years after cardiac myxoma resection. Pract Neurol 2023; 23:519-520. [PMID: 37487705 DOI: 10.1136/pn-2023-003705] [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] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Roberto Mendes Franco
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Neurology, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - José Sousa
- Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Mariana Matos
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Internal Medicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Luís Albuquerque
- Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Pedro Abreu
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
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4
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Sharma P, Kumble YA, Shrestha AB, Jaiswal V. A case report of left atrial myxoma presenting as embolic stroke. Clin Case Rep 2023; 11:e8022. [PMID: 37841884 PMCID: PMC10568041 DOI: 10.1002/ccr3.8022] [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: 05/16/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Key Clinical Message Embolic stroke may rarely be the first presenting symptom of atrial myxoma. Multiple infarcts should be evaluated for embolic causes. Correct etiological diagnosis in cardio-embolic stroke guides proper management strategy. It reinforces on the importance of early echocardiogram in the initial evaluation of patients presenting with ischemic stroke. Abstract Atrial myxoma is a benign cardiac tumor found most commonly in the left atrium in 80% of the cases. Almost 1 in 10 myxomas are familial and are most common in women. Cardiac myxoma mostly present with dyspnea, fatigue, or palpitations. Previously undiagnosed left atrial myxoma (LA) presenting as stroke is extremely rare. Authors describe the case of a middle-aged man with LA myxoma presenting with acute ischemic embolic stroke that was surgically excised. This case report emphasizes on the rare presentation as embolic stroke and the role of cardiac imaging in patients presenting with ischemic stroke. Early and coordinated teamwork among the neurologist, cardiologist, and cardiothoracic surgeon help establish the etiology and provide appropriate treatment.
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Affiliation(s)
- Prachi Sharma
- LPS Institute of CardiologyKanpurUttar PradeshIndia
- Indiana hospital and heart instituteMangaloreKarnatakaIndia
| | | | | | - Vikash Jaiswal
- Department of Research and Academic AffairsLarkin Community HospitalSouth MiamiFloridaUSA
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5
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Nguyen HQ, Chau ANT, Doan KQ, Tran NCT. Assessment of embolic cardiomyopathy from atrial myxoma on magnetic resonance imaging: A case report. Radiol Case Rep 2023; 18:3014-3019. [PMID: 37441458 PMCID: PMC10333107 DOI: 10.1016/j.radcr.2023.05.069] [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: 03/01/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/15/2023] Open
Abstract
Atrial myxoma is the most common benign cardiac tumor, which can present with diverse symptoms. Systemic embolism is a frequent complication, affecting up to one-third of cases and frequently involving cerebral arteries. However, cardiac myxoma-induced myocardial infarction (MI) is rare. We report a case of a 56-year-old man presenting with predominant neurological symptoms and an unexplained elevation of hs-Trop T without clinical signs of acute MI. Computerized tomography of the head showed no acute lesions, but subsequent magnetic resonance imaging (MRI) revealed multiple small ischemic lesions and old microhemorrhage foci. A comprehensive cardiovascular investigation was performed. Ultrasonography revealed a left atrial mass. Cardiac MRI confirmed the mass was an atrial myxoma, and showed many old infarctions and scarring lesions in the cardiac muscle. The patient underwent tumor resection, but residual motor-neurological deficits were observed. This case emphasizes the importance of cardiac MRI in the diagnosis of multiple focal infarctions attributed to coronary embolism.
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Affiliation(s)
- Hien Quang Nguyen
- Radiology Department, Thu Duc city Hospital, Ho Chi Minh city, Vietnam
| | | | - Khien Quoc Doan
- Radiology Department, Thu Duc city Hospital, Ho Chi Minh city, Vietnam
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Ma K, Zhao D, Li X, Duan H, Yan C, Wang S, Zeng L, Xu K, Lai Y, Chen B, Mu N, Yang C, Quan Y, Li Z, Wang X, Feng H, Li F. Case report: Multiple brain metastases of atrial myxoma: Clinical experience and literature review. Front Neurol 2023; 13:1046441. [PMID: 36845225 PMCID: PMC9944787 DOI: 10.3389/fneur.2022.1046441] [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: 09/16/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023] Open
Abstract
Myxoma is the most common type of benign cardiac tumor in adults, and it has a strong tendency to embolize or metastasize to distant organs. Patients with multiple brain metastases have rarely been seen in clinics; hence, standard treatment protocols for multimyxoma metastasis in the brain have not been established. We present the case of a 47-year-old female who had convulsions in the right hand and repeated seizures. Computed tomography revealed multiple tumor sites in her brain. Craniotomy was conducted to remove the tumor sites. However, recurrent brain tumors and unexpected cerebral infarctions occurred frequently shortly after the treatment because the cardiac myxoma had not been treated due to the patient's personal concerns. The myxoma was resected by gamma knife radiosurgery, and temozolomide was given prior to cardiac surgery. There has been no evidence of tumor recurrence from the 2 years following the surgery until the present. This case highlights the importance of prioritizing cardiac lesions over cerebral lesions; if a cerebral metastasis has been found, it is likely that the cardiac myxoma is already unstable, with high rates of spread and metastasis. Therefore, it is unwise to treat metastasis sites before the cardiac myxoma. Additionally, the case suggests that gamma knife radiosurgery combined with temozolomide is effective as treatment for multiple myxoma metastasis in the brain. Compared with conventional cerebral surgery, gamma knife radiosurgery is safer, causes less bleeding, and requires a shorter time for recovery.
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Affiliation(s)
- Kang Ma
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dawei Zhao
- Department of Neurosurgery, Chongqing Sanbo Changan Hospital, Chongqing, China
| | - Xuegang Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haijun Duan
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chaojun Yan
- Department of Cardiosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shi Wang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Zeng
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kai Xu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Lai
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Beike Chen
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ning Mu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuanyan Yang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yulian Quan
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhengyang Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fei Li
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China,*Correspondence: Fei Li ✉
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7
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Shin C, Ju MH, Lee CH, Lim MH, Je HG. Surgical Outcomes of Cardiac Myxoma Resection Through Right Mini-Thoracotomy. J Chest Surg 2023; 56:42-48. [PMID: 36517950 PMCID: PMC9845859 DOI: 10.5090/jcs.22.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 12/16/2022] Open
Abstract
Background With recent advances in cardiac surgery through minimal access, mini-thoracotomy has emerged as an excellent alternative for cardiac myxoma resection. This study analyzed the surgical results of this approach, focusing on postoperative cerebral embolism and tumor recurrence. Methods We retrospectively reviewed 64 patients (mean age, 56.0±12.1 years; 40 women) who underwent myxoma resection through mini-thoracotomy from October 2008 to July 2020. We conducted femoral cannulation and antegrade cardioplegic arrest in all patients. Patient characteristics and perioperative data, including brain diffusion-weighted magnetic resonance imaging (DWI) findings, were collected. Medium-term echocardiographic follow-up was performed. Results Thirteen patients (20.3%) had a history of preoperative stroke, and 7 (11.7%) had dyspnea with New York Heart Association functional class III or IV. Sixty-one cases (95.3%) had myxomas in the left atrium. The mean cardiopulmonary bypass and cardiac ischemic times were 69.0±28.6 and 34.1±15.0 minutes, respectively. Sternotomy conversion was not performed in any case, and 50 patients (78.1%) were extubated in the operating room. No early mortality or postoperative clinical stroke occurred. Postoperative DWI was performed in 32 (53%) patients, and 7 (22%) showed silent cerebral embolisms. One patient underwent reoperation for tumor recurrence during the study period; in that patient, a genetic study confirmed the Carney complex. Conclusion Mini-thoracotomy for cardiac myxoma resection showed acceptable clinical and neurological outcomes. In the medium-term echocardiographic follow-up, reliable resection was proven, with few recurrences. This approach is a promising alternative for cardiac myxoma resection.
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Affiliation(s)
- Changwon Shin
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Min Ho Ju
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Chee-Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Hee Lim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyung Gon Je
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea,Corresponding author Hyung Gon Je Tel 82-55-360-2127 Fax 82-55-360-2157 E-mailORCIDhttps://orcid.org/0000-0003-4713-2898This paper was presented at the 52nd Fall Meeting of the Korean Society for Thoracic and Cardiovascular Surgery
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8
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Muacevic A, Adler JR, Ramanna N. Recurrent Left Atrial Myxoma: The Significance of Active Surveillance. Cureus 2023; 15:e33990. [PMID: 36687289 PMCID: PMC9854205 DOI: 10.7759/cureus.33990] [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] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Cardiac myxoma recurrence is uncommon following surgical resection. Recurrence is about 2-3% in familial cases; however, recurrence is uncommon in sporadic cases. Most of the recurrences will occur during the first three to four years. Ten percent of myxomas are of the inherited autosomal dominant disorder called Carney's complex, while the rest appear sporadic. We are reporting a nonfamilial case of atrial myxoma, recurring rapidly seven years after resection of the initial left atrial myxoma with a pathologically proven clear margin and no malignant transformation. Cardiac neoplasms are rare and occur less commonly than metastatic disease of the heart. Congestive heart failure symptoms and thromboembolism account for nearly half of the presenting signs and symptoms. The initial presentation of our case was an embolic phenomenon, presenting with a stroke. The patient subsequently underwent resection of the mass, with pathology confirming the complete excision of the myxoma with a clear margin and no evidence of malignant transformation. Our patient was closely followed up in the clinic on annual transthoracic echocardiography surveillance, with a recurrence noted on surveillance echocardiography in 2021 (seven years after initial diagnosis) despite the patient being asymptomatic. This case illustrates transthoracic echocardiography as the mainstay of detection of recurrent left atrial myxoma; however, it also asks the question of how often patients need to be screened for recurrence of left atrial myxoma and for how long they need to have surveillance echocardiography. Clinical presentation and transesophageal echocardiographic views are extremely helpful in sharpening the accuracy of the diagnosis.
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9
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Rosen JL, Yost CC, Wong DH, Mandel JL, Prochno KW, Komlo CM, Ott N, Guy TS. Routine endoscopic robotic cardiac tumor resection using an 8-mm working port and percutaneous cannulation. J Card Surg 2022; 37:4803-4807. [PMID: 36423256 DOI: 10.1111/jocs.17166] [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: 09/24/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prior studies have demonstrated robotic excision of cardiac tumors as a safe and effective treatment option. The procedure is performed with five incisions: three robotic arm ports, one atrial retractor port, and one working port. We report our unique initial experience in robotic tumor removal. To our knowledge, this is one of the first reports demonstrating cardiac myxoma and fibroelastoma removal with use of exclusively 8-mm ports. METHODS All data for robotic cardiac tumor resection at our institution from June 2019 to December 2021 were retrospectively collected; 18 cases were included, including 13 cardiac myxomas and five fibroelastomas. Baseline demographics, intraoperative characteristics, and surgical outcomes were recorded. Descriptive statistics were calculated; continuous variables were reported as median [interquartile range], and categorical variables were reported as percentages. RESULTS Median patient age was 64 [55, 70] years old. The cohort consisted of primarily female (67%) and white (83%) patients. Median body mass index was 26.3 [23.0, 31.5] kg/m2 . 11% of patients were current tobacco users and 50% had hypertension. All patients underwent myxoma or fibroelastoma removal with the use of five 8-mm robotic ports. Each patient underwent percutaneous cannulation via the femoral arteries. Aortic occlusion was achieved via an endoaortic balloon (67%) or transthoracic cross-clamp (33%). Cross-clamp time was 30 [26, 41] minutes. Concomitant procedures performed during myxoma removal included patent foramen ovale closure (28%), mitral valve repair (8%), left atrial appendage closure (8%), Cox-maze procedure (6%), and coronary artery bypass grafting (6%). All cardiac tumors were packaged with use of the endo-bag and subsequently removed through the working port. Maximal myxoma and fibroelastoma diameters were 2.5 [1.7, 3.5] and 0.6 [0.4, 0.7] cm, respectively. Procedural cardiopulmonary bypass time was 77 [65, 84] minutes. No intraoperative mortality, reoperation for bleeding, or postoperative cardiac issues were recorded. One in-hospital mortality occurred as the result of a thrombotic event in the context of a hypercoagulable state unrelated to the patient's operation. No other mortalities were observed at 30 days. Hospital length of stay was 4.5 [3.0, 7.8] days. CONCLUSIONS In our study, the robotic platform facilitated safe and effective cardiac tumor excision. Our results highlight the efficacy of 8-mm port sizing and the concurrent use of other minimally invasive techniques, including percutaneous cannulation, in this patient population. In general, patients prefer the least invasive treatment option available. Our findings emphasize the importance of training cardiac surgeons to perform robotic procedures using the least invasive means possible to provide patients with various options for their treatment.
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Affiliation(s)
- Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin C Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniella H Wong
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jenna L Mandel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kyle W Prochno
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Caroline M Komlo
- Division of Cardiac Surgery, Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Nathan Ott
- Department of Surgery, Northwell Health Staten Island, New York City, New York, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Pennsylvania, Philadelphia, USA
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Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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.
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Ku L, Cheng Y, Ma X. A rare left atrial myxoma associated with multiple intracranial aneurysms. J Card Surg 2022; 37:2414-2415. [PMID: 35599013 DOI: 10.1111/jocs.16621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Leizhi Ku
- Department of Radiology Wuhan Asia Heart Hospital Wuhan China
| | - Youping Cheng
- Department of Pathology Wuhan Asia General Hospital Wuhan China
| | - Xiaojing Ma
- Department of Echocardiography Wuhan Asia Heart Hospital Wuhan China
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12
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Rao J, Tao Z, Bao Q, Xu M, Jiang M, Weng X, Yin B, Li D, Li Y, Cai X, Fu F. Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis. Front Neurol 2022; 13:877056. [PMID: 35509996 PMCID: PMC9058073 DOI: 10.3389/fneur.2022.877056] [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: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) is a common and life-threatening complication of patients with cardiac myxoma (CM). The role of the mechanical thrombectomy (MT) technique in CM-AIS patients remains unclear, and no guidelines exist for this population. Therefore, we conducted a case series study of MT in CM-AIS patients to investigate its safety and efficacy via a pooled analysis of published literature. Methods Eleven CM-AIS patients who underwent MT between 2016 and 2021 were screened from multicenter stroke databases. Clinical, procedural, and outcome data were obtained from medical records. A systematic review was conducted to identify additional cases from published studies by searching PubMed and China National Knowledge Infrastructure databases. We then performed a pooled analysis of the published cases. Results In the case series study, most patients were male (81.8%), with a median age of 51 years. All patients had CM located in the left atrium. The rate of successful reperfusion using the first-line thrombectomy technique was 100% with stent retriever (SR) and 66.7% with direct aspiration (DA), which resulted in overall successful reperfusion in 94.1% of all occlusions. The retrieved emboli of the five patients who underwent histopathology examination were identified as myxoma components. Hemorrhagic transformation was observed in five (45.5%) patients, of whom one was symptomatic (9.1%). Three-month favorable functional outcomes were achieved in five (45.5%) patients with a 3-month mortality rate of 18.2%. For the literature review, 35 cases with 51 target vessel occlusions were identified and included in the pooled analysis. The rate of successful reperfusion following first-line thrombectomy did not differ between SR (30 patients, 90.9%) and DA (10 patients, 83.3%). The overall successful reperfusion rate was 91.8% of all occlusions. Three-month favorable functional outcomes were achieved in 21 (60.0%) patients, and the mortality rate was 8.6%. Conclusions Our findings suggest that MT is not only an effective technique but also a safe option for CM-AIS patients with large vessel occlusion. MT has several advantages for this population, which include a high recanalization rate, low bleeding risk, and the ability to evaluate the source of emboli and the etiology of stroke.
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Affiliation(s)
- Jie Rao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Zi Tao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongqiong Bao
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mengbei Xu
- Department of Neurology, Ningbo Second Hospital, Ningbo, China
| | - Mingxia Jiang
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiongpeng Weng
- Department of Neurology, Huangyan Hospital, Wenzhou Medical University, Taizhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dandong Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Li
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- Xueli Cai
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Fangwang Fu
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13
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Ran H, Chen G, Hu J, He Y, Liu J, Li F, Liu H, Zhang T. Case Report: Biatrial Myxoma With Pulmonary Embolism and Cerebral Embolism: Clinical Experience and Literature Review. Front Cardiovasc Med 2022; 9:812765. [PMID: 35187128 PMCID: PMC8849234 DOI: 10.3389/fcvm.2022.812765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac myxoma is a common benign primary intracardiac tumor in the general population, and it is generally characterized as a benign tumor, and the morbidity of biatrial myxoma is low. Cases of biatrial myxoma in young patients are extremely rare. Furthermore, severe complications of cardiac myxoma, such as cerebral embolism, can have fatal consequences. Imaging can effectively assist in making a correct diagnosis and a safe and efficient surgical treatment plan. In this case report, we describe a unique case of a young woman who presented with biatrial myxoma accompanied by pulmonary embolism and cerebral embolism. Computed tomography pulmonary angiography (CTPA) detected multiple filling defects in the bilateral cardiac and bilateral inferior pulmonary artery basal branches. Transthoracic echocardiography (TTE) revealed irregular isoechoic masses in the bilateral atrium. Postoperative histopathology confirmed a biatrial myxoma. The patient was discharged on the ninth day after surgery.
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Wang A, Wang Z, Hu K, Liu J, Cao Q, Zhang Z, Si Z. Delayed multiple intracranial aneurysms caused by left atrial myxoma: a case report and literature review. Transl Pediatr 2022; 11:149-156. [PMID: 35242661 PMCID: PMC8825931 DOI: 10.21037/tp-21-11] [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] [Received: 01/09/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial aneurysm may appear even after the removal of the cardiac myxoma. However, the pathogenesis and treatment of such aneurysm lesions are not clear. The study aimed to explore the clinical and imaging manifestation, hypothetical pathogenesis, and therapy in one case of left atrial myxoma causing multiple intracranial aneurysms. A 14-year-old male displayed a 3-hour history of episodic loss of consciousness and right hemiplegia after a leapfrog-like movement. The myxoma was diagnosed by a combination of clinical examination, leading to the diagnosis of mitral dynamic obstruction with a Grade III mitral diastolic murmur and tumor plop; magnetic resonance imaging, revealing multiple ischemic sites in both semi-oval centers; and transthoracic echocardiography, demonstrating a mitral valve obstruction. The myxoma was removed surgically; however, computed tomography angiography showed multiple intracranial aneurysms in both middle cerebral arteries 18 months after resection of the atrial myxoma. After conservative treatment, the patient had no neurological dysfunction symptoms for 5 years after myxoma resection. His condition is relatively stable. In conclusion, resection of the atrial myxoma may eliminate the early neurological symptoms, but it cannot ensure the nonoccurrence of delayed intracranial aneurysms. The neoplastic process theory was favored for explaining the aneurysm development in this case. According to the specific conditions of the patient, a combination of open surgery, chemotherapy, radiotherapy, and coil embolization is recommended.
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Affiliation(s)
- Aihua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Zhaoxia Wang
- Department of Neurology, Juxian People's Hospital, Rizhao, China
| | - Ke Hu
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Emergency Medicine, Jinan, China
| | - Jinzhi Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Qiwei Cao
- Department of Pathology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pathology, Shandong Lung Cancer Institute, Shandong Institute of Nephrology, Jinan, China
| | - Zixian Zhang
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Zhihua Si
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
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