Left atrial intramural hematoma after removal of atrial myxoma: cardiac magnetic resonance in the differential diagnosis of intra-cardiac mass

Left atrial intramural hematoma: The role of echocardiography

Left atrial intramural hematoma (LAIH) is an uncommon entity for which a timely diagnosis is critical for decision making. Cardiac surgical or catheter-based procedures are potential causing factors. Though cardiac computerized tomography and magnetic resonance are highly accurate diagnostic modalities, their role is limited by the lack of widespread availability. The present clinical case illustrates the diagnostic features of LAIH that can be obtained using echocardiography at the bedside in critically ill patients. We report a case of LAIH, that followed a catheter ablation procedure and was complicated by cardiac and cerebral ischemia. Cardiac surgical management was required.

A Rare Cause of Left Atrial Mass

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LAIH may be a complication of blunt chest trauma.

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Multimodality imaging with TEE and CMR can lead to the correct diagnosis.

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Conservative management may be considered in hemodynamically stable patients.

Conservative management of a rare case of atrial septal hematoma after pediatric cardiac surgery

Atrial septal hematoma is uncommon complication that may happen after any cardiac intervention. Although it is rare, it can pose a challenging situation in the postoperative care. Multiple management approaches has been described with different outcomes. Here we are reporting a boy, aged 13 years, with dilated aortic root who underwent aortic root replacement with valve preservation. Postoperative course was complicated by atrial septal hematoma. A nonsurgical management approach was chosen based on the patient clinical condition. Regression in size with complete resolution of the hematoma was observed during the follow up.

Evaluation of the potential predictors of embolism in patients with left atrial myxoma

INTRODUCTION

Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma.

METHODS

This single-center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism.

RESULTS

The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752-0.964; P < 0.001).

CONCLUSION

The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism.

A Rare Case of Left Subacute Atrial Dissection: Multimodality Imaging Approach

Today, left atrial dissection is described as a rare complication of cardiac surgery, particularly after a mitral valve replacement. We report a rare case of left subacute atrial dissection occurred as a result of a domestic accidental fall. Transesophageal echocardiogram, angio-computed tomography, and magnetic resonance imaging showed an intramural formation with clear margins and a seamless cleavage with the posterolateral wall of the left atrium, which determined an obstacle to the ventricular filling. The patient was then operated in order to empty the hematoma and reattach the atrial wall.

An unusual echocardiographic presentation of left atrial dissection following cardiopulmonary cerebral resuscitation

Left atrial dissection (LatD) is a relatively rare perioperative complication during mitral valve repair. Here, we report a 64-year-old man who developed LatD after cardiopulmonary resuscitation was needed due to an extensive myocardial infarction. Aggressive cardiac massage resulted in cardiac rupture and massive bloody pleura effusion. Intraoperative three-dimensional transesophageal echocardiography revealed posterior-medial papillary muscle ruptured and separation of the endocardium from the left atrial myocardium. We speculate that this is the first report in the literature of LatD after cardiopulmonary cerebral resuscitation.

Astrocyte elevated gene-1 regulates CCL3/CCR5-induced epithelial-to-mesenchymal transition via Erk1/2 and Akt signaling in cardiac myxoma

In recent years, astrocyte elevated gene-1 (AEG-1) has been reported as a key mediator that is involved in the epithelial-to-mesenchymal transition (EMT) process. However, the mechanisms underlying CCL3/CCR5-AEG-1 pathway-mediated EMT in cardiac myxoma (CM) has not been well featured till now. We used immnohistochemistry and immunoblotting to assess the expression of CCR5 and AEG-1 in 30 cases of CM tissues and cells. Subsequently, cultured CM cells were treated with si-AEG-1 or si-CCR5 and then subjected to in vitro assays. We observed that CCR5 and AEG-1 proteins were highly expressed in CM tissues (73.3 and 76.7%, respectively) and closely correlated with tumor size (>5 cm). Importantly, we validated the expression of AEG-1, p-Erk1/2, p-Akt, vimentin, N-cadherin and MMP2 increased in the CM cell with CCL3 treatment in a time- and concentration-dependent manner. When CM cells were treated with si-CCR5, the expression of AEG-1, p-Erk1/2, p-Akt, vimentin, N-cadherin and MMP2 was downregulated. In addition, when CM cells were treated with si-AEG-1, the expression of p-Erk1/2, p-Akt, vimentin, N-cadherin and MMP2 was also downregulated. Using the cell cycle and proliferation assay, the knockdown of AEG-1 inhibited the entry of G1 into S phase and the proliferation capacity of CM cells. In conclusion, AEG-1 mediates CCL3/CCR5-induced EMT development via both Erk1/2 and Akt signaling pathway in CM patients, which indicates CCL3/CCR5-AEG-1-EMT pathway could be suggested as a useful target to affect the progression of CM.