"Left atrial myxoma - A tumor in transit"

Atrial Myxoma: Presenting as a Large Splenic Infarction

Cardiac myxomas are the most common benign primary heart tumors, with the majority occurring in the left atrium. Clinical manifestations are a result of constitutional, obstructive, and/or embolic events. Complications include myocardial infarction and stroke, as well as renal and limb ischemia. Our unusual case is a middle-aged female who presented with a one-week history of progressively worsening abdominal pain and was found to have a large splenic infarction on a CT scan. There was no personal or family history of autoimmune diseases or hypercoagulable states. The evaluation revealed a large left atrial myxoma confirmed on biopsy after surgical resection. Our patient's clinical presentation was relatively benign compared to the size of her mass. Although her myxoma was very large, morphologically solid, and attached to the interatrial septum, she did not have any evidence of congestive heart failure. The tumor's irregular surface and mobility likely led to splenic embolization. Hence, the differential diagnosis of splenic infarction should include left atrial myxoma.

Epidemiology of Cardiac Myxoma in the Kingdom of Bahrain

BACKGROUND

Cardiac myxomas (CM) are the most prevalent type of primary cardiac tumour. The majority of primary cardiac tumours, including CM, are found to be benign. In the context of this study, the objective was to investigate and analyse the experience of CM over a period of 10 years, specifically in Bahrain. By examining this particular subset of cardiac tumours, valuable insights can be gained regarding their prevalence, clinical presentation, diagnostic methods, treatment approaches, and outcomes in the Bahraini population.

METHODS

We retrospectively evaluated the medical records of 20 patients who presented with CM at the Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre in the Kingdom of Bahrain from January 2010 to January 2021. All patients had transthoracic echocardiography to establish a preoperative diagnosis. All of the patients underwent an operation using the median sternotomy, and a histopathology examination confirmed the final diagnosis.

RESULTS

The mean age at the time of presentation was 57 (± 18.1) years, ranging from 17 to 80 years, and 55% (12 patients) were female. Dyspnea (n=8, 40%) and peripheral embolism (n=4, 20%), which include cerebrovascular accidents and acute monocular vision loss, were the most frequently observed symptoms. The largest diameter of the myxoma was 5.1 cm (±1.7). The left atrium was the predominant location for myxoma formation (n=16, 80%), with the majority of the myxomas attached to the atrial septum.

CONCLUSION

CM poses a significant risk of cardiac and systemic complications. Early detection and timely gross-complete resection result in excellent early and long-term outcomes.

Embolism from a left ventricular myxoma presenting with acute limb ischaemia

Acute limb ischaemia (ALI) secondary to cardiac myxoma is uncommon. Embolic myxoma should be considered a differential diagnosis in young patients with ALI who do not have apparent cardiovascular risk factors. A multidisciplinary approach and comprehensive care can improve outcomes and optimise the collaborative treatment of ALI. Early referral to a hospital that can provide specialised treatment for ALI helps prevent significant tissue loss and surgical complications, such as amputation.A man in his 20s presented with bilateral ALI of both lower extremities, and an arterial duplex scan revealed a thrombus occluding all arterial segments of the bilateral lower extremities. An intracardiac mass adherent to the apical and anterior interventricular septum on two-dimensional echocardiography suggested a complex myxoma. The patient was diagnosed with ALI Rutherford category III, and bilateral hip disarticulation was performed. The patient was discharged with an anticoagulant.

Visual analysis based on CiteSpace software: a bibliometric study of atrial myxoma

Objective

To use CiteSpace and VOSviewer visual metrology to analyze the research status, frontier hotspots, and trends in research on atrial myxoma.

Methods

The Web of Science core collection database was used to retrieve relevant literature on atrial myxoma from 2001 to 2022. CiteSpace software was used to analyze keywords with a co-occurrence network, co-polymerization class, and burst terms, and a corresponding visual atlas was drawn for analysis.

Results

A total of 893 valid articles were included. The country with the highest number of articles was the United States (n = 186). The organization with the highest number of articles was the Mayo Clinic (n = 15). The author with the highest number of articles was Yuan SM (n = 12). The highest cited author was Reynen K (n = 312). The highest cited journal was Annals of Thoracic Surgery (n = 1,067). The most frequently cited literature was published in the New England Journal of Medicine in 1995, which was cited 233 times. The keywords co-occurrence, copolymerization analysis, and Burst analysis revealed that the main research focuses were surgical methods, case reports, and genetic and molecular level studies on the pathogenesis of myxoma.

Conclusions

This bibliometric analysis revealed that the main research topics and hotspots in atrial myxoma included surgical methods, case reports, genetic and molecular studies.

Surgical treatment of rare pediatric cardiac myxomas:12 years clinical experience in a single institution

BACKGROUND

Primary cardiac tumors are rare, and cardiac myxoma (CM) accounts for the majority of these tumors. Most of the reports in the literature are case reports. This study summarizes our clinical experience in the surgical treatment of CM over the past 12 years.

METHODS

We retrospectively analyzed the clinical data of 23 children with CM(8 boys, 15 girls; median age: 8.92 months, range: 2 years 5 months-12 years 9 months; body weight: 11-45 kg, median body weight: 28.21 kg) admitted to our hospital in the previous 12 years, and we statistically analyzed their clinical manifestations and surgical methods.

RESULTS

23 cases underwent myxoma excision under cardiopulmonary bypass(CPB). The follow-up period was 0.2 to 12.6 years (mean:7.2 years). Two patients could not be traced, and the follow-up completion rate was 91.30%. One patient (4.35%) died of myocardial infarction early after surgery with low continuous cardiac output. There were no cerebral embolism, acute heart failure, atrioventricular block and other related complications in 19 cases. A patient with cerebral infarction complicated with right hemiplegia recovered well after rehabilitation treatment. There was no recurrence of CM in 19 cases and all patients recovered after surgery. One patient relapsed 5 years after surgery, and no tumor recurrence was observed after the second surgery. Among the 20 long-term survivors, 13 (65.00%) were NYHA Class I patients and 7(35.00%) were NYHA Class II patients.

CONCLUSIONS

Although CM in children is rare, it may cause cerebral infarction and other multi-organ embolism. Once CM is found and removed as soon as possible, it can reduce serious complications. If the complete resection is possible, surgery provides better palliation. Follow-up echocardiographic should be paid attention to after surgery.

Features of the Blood Supply of Cardiac Myxoma which Can Cause Bleeding

With a mortality rate of 1 % to 5 %, surgical treatment of cardiac myxomas (CM) may be complicated by the development of intra- or postoperative bleeding, among other things. The aim. To present an unusual case of surgical treatment of left atrial myxoma with the occurrence of intraoperative bleeding, which was due to extremely rare features of the coronary circulation with a special blood supply to the base of the CM. Case report. Female patient R., 65 years old, case record No.3686, was admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with diagnosis of CM. Coronary angiography revealed unique features of coronary circulation: an arteriovenous malformation from the distal parts of the circumflex branch of the left coronary artery with discharge into the right parts of the heart was revealed. On 9/20/2022, urgent operation of resection of the myxoma of the left atrium (LA) was performed. After removal of the myxoma and sealing of the heart, accumulation of arterial blood was found in the area of the inferior vena cava (IVC) and the interatrialsulcus. Revision of the left atrium cavity was performed again:all intracardiac sutures in the area of the myxoma base were duplicated. After repeated resealing of the heart chambers, bleeding from the IVC region stopped after administration of protamine sulfate and tight tamponade of the space under the IVC. Tampons were removed from the pericardial cavity after 72 hours. Results. The source of the bleeding could be the site of the malformation of the coronary arteries, which is a tangle of small vessels located in the projection of the base of the myxoma below the point where the IVC meets the right atrium. During the histological examination of the myxoma, large full-blood vessels of the sinusoidal type were revealed, around which, due to damage to their thin walls, hematomas formed, giving the tumor a spotted appearance. The peculiarity of this tumor was the presence of a very large vascular plexus at its base; it had the appearance of a cluster of sections of numerous, different-sized, deformed and remodeled arteries. These data were confirmed by coronary angiography. Conclusions. Studying the data of coronary angiography with the analysis offeatures of localization of coronary arteries, as well as the presence of possible coronary malformations, can provide information that allows predicting the possibility of their damage, especially in the case of localization in the place of possible surgical manipulation. In the event of bleeding, one of the optimal methods of its elimination is the use of long-term tamponade.

A Case Report on the Incidental Diagnosis of a Left Atrial Myxoma in a Patient Presenting With Right Shoulder Pain and Inter-scapular Back Pain

Primary cardiac tumors are rare, and myxoma is a rare benign primary cardiac tumor in adults, commonly found within the left atrium. The presentation can vary from patients being asymptomatic to pulmonary embolism or stroke. Smaller atrial myxomas are usually asymptomatic, however, larger ones can cause symptoms such as dyspnea, orthopnea, cough, peripheral edema, palpitations, and fatigue. We present a case report of a 72-year-old patient presenting with right shoulder pain and chest pain on breathing to the accident and emergency department. The patient was complaining of right shoulder pain for five days and pleuritic chest pain for the last 48 hours. Initial electrocardiogram showed normal sinus rhythm, however, repeat electrocardiograms showed atrial fibrillation. An echocardiogram showed a homogeneous, relatively round mass seen in the left atrium, close to the inter-atrial septum, and close to the roof of the left atrium, and the patient underwent surgical removal of the benign tumor.

Incidental Finding of an Exceptionally Large Left Atrial Myxoma Presenting as an Acute Cardioembolic Stroke

Left atrial myxomas are rare tumors that arise in the left atrium of the heart. As they become larger, they tend to grow into the atrial lumen and disrupt cardiac hemodynamics. Commonly reported symptoms include dyspnea, orthopnea, cough, peripheral edema, and fatigue. On physical examination, a characteristic “tumor plop” may be heard in some patients early in diastole. Left atrial myxomas may cause emboli to be released into the systemic circulation, which can lead to acute cardiovascular events, including strokes. We present the case of a 43-year-old female with sudden-onset slurred speech, left facial droop, and left-sided hemiplegia. CT angiography of the brain revealed a right middle cerebral artery infarct, and the patient underwent emergent mechanical thrombectomy. Upon workup for secondary causes of stroke, echocardiogram revealed an incidental 8 cm left atrial myxoma. After stabilization in the ICU, the patient was taken to surgery and the tumor was successfully removed. Over the course of admission, the patient’s left-sided hemiplegia gradually improved, and she was eventually transferred to inpatient rehabilitation care. A multidisciplinary effort involving medicine teams, neurology, cardiology, cardiothoracic surgery, neuro-interventional radiology, pain management, and endocrinology was essential in reaching the diagnosis. This case highlights the importance of considering a primary cardiac tumor such as a left atrial myxoma in the differential diagnosis when evaluating for secondary causes of acute ischemic stroke.

Atypical interstitial granuloma annulare: a possible uncommon systemic manifestation of atrial myxomas

A 73-year-old man presented with lower back pain and bilateral palmar lesions. Urine culture grew Streptococcus agalactiae and C-reactive protein was raised. He was treated with antibiotics for urinary tract infection with suspected pyelonephritis. An echocardiogram ordered to look for infective endocarditis was suggestive of a left atrial myxoma. He subsequently developed an acute right common iliac artery embolus, which resolved with conservative management. He underwent a successful open-heart left atrial mass and appendage resection, with histopathology confirming atrial myxoma. Skin biopsies of the lesions ten weeks post onset showed granuloma annulare of the palms.