Myxoma – ABC CARDIOL

ABCIC

Case Report

Giant Atrial Myxoma in a Pregnant Patient: A Case Report

Roberto Ramos Barbosa et al. Caio Badiani Prando Victor Macedo Bianchini Lucas Crespo de Barros … Larissa Novaes Paganini Gracielly Barros Darlan Dadalt Sergio Luis Santos Guedes Vinicius Eduardo Araújo Costa Marcus Gustavo Tito Tiago Bernardo Nery Marcio Vinicius de Nardi de Angeli Maria Eduarda Vichi Gomes Viana Mariana Oliveira Roncato João Paulo Moulin Auad Guilherme Freitas Fernandes de Oliveira Renato Giestas Serpa Osmar Araujo Calil Luiz Fernando Machado Barbosa

Introduction

Atrial myxoma is the most prevalent primary heart tumor.^, Clinical manifestations of myxomas are usually nonspecific, and they may present with dyspnea, fatigue, reduced functional capacity, edema, and, eventually, cerebral embolic events with focal neurological deficits. Although they are classified as benign neoplasms, most commonly located in the left atrium, they can cause obstruction of intracardiac blood flow and, when friable, systemic embolism with consequent tissue ischemia.^,

In spite of higher prevalence in women (65%), diagnosis during pregnancy is considered uncommon, with greater challenges in treatment and an increased risk of fetal death. We report the case of a pregnant patient with a complication of atrial myxoma that manifested during labor.

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ABCIC

Case Report

A Common Primary Cardiac Tumor With an Uncommon Presentation

Juan Felipe Vasquez-Rodriguez et al. Carolina Paola Idrovo-Turbay Jaime Alberto Rodríguez Lorena Montes Villalobos

Abstract

Background

Cardiac tumors are rare, and most are secondary (metastatic) lesions. Primary tumors, though uncommon, are typically benign, with myxomas being the most frequent and occasionally displaying unique features. Diagnosis often requires multimodality imaging.

Case summary

A 41-year-old man with a history of ischemic stroke and resection of an apical left ventricular myxoma presented for evaluation after a follow-up transthoracic echocardiogram (TTE) revealed a mobile, ovoid apical lesion with high embolic risk, despite being asymptomatic. Cardiac magnetic resonance (CMR) imaging suggested recurrence of the ventricular myxoma. Surgical resection was performed, and histopathology confirmed the diagnosis of cardiac myxoma (CM).

Discussion

CMs are the most common primary benign cardiac tumors, typically located in the left atrium and attached to the interatrial septum. They are less frequently found in the ventricular cavities. About half of cases are asymptomatic, and recurrence is possible after resection. This case highlights a rare instance of late recurrence in an atypical location.

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ABCIC

Case Report

Atrial Myxoma as a Rare Cause of Stroke: Case Report

Maurício Ângelo de Almeida Junior et al. Ana Flavia Parreira de Morais Jamil Alli Murad Junior

Introduction

Atrial myxoma (AM) is the most common primary benign tumor affecting the heart. Its prevalence is rare, estimated at 0.03% in the general population. Surgical intervention should be introduced as soon as diagnosed due to the increased risk of cardiac complications, such as intracardiac obstructions or systemic embolizations.

Cardiac myxomas are commonly observed in the left atrium in >75% of cases, predominantly attached with a stalk to the fossa ovalis (>90%). However, they can be seen in other locations (left ventricle, right atrium, and, though quite rarely, the right ventricle).

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IJCS

Case Report

Six-Year Follow-Up of an Octogenarian With a Left Atrial Myxoma: Case Report

Miguel Bernardino Antunes Vicente et al. Tânia Amaro Elsa Fernandes

Abstract

Myxoma is the most common primary cardiac tumour, especially in adults. However, reports on this nosological entity in patients over the age of 80 are scarce in the medical literature. Echocardiography is a useful diagnostic tool for detecting cardiac myxomas. These tumours are usually surgically removed soon after diagnosis, limiting knowledge of their natural evolution. In this report, we describe the case of an 86-year-old woman who had been followed irregularly for arterial hypertension since 2016, when an echocardiogram showed a left atrial myxoma adhered to the interatrial septum, initially without impairment of the mitral valve (MV) or obstruction of the pulmonary veins (PV). The patient refused surgical removal at the time. Six years later, she was hospitalized for urinary sepsis. A new echocardiogram revealed an increase in the size of the myxoma, which occupied around 80% of the left atrium (LA), obstructing the PV and MV. New suggestion of surgery was refused by the patient.

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ABC

Case Report

Acute ST-Elevation Myocardial Infarction in a Young Adult: Rare Presentation of Giant Atrial Myxoma

Rodrigo Rufino Pereira Silva et al. Carolina Jerônimo Magalhães Rafael Silvestre Vieira da Silva Giulia Antoni Ferreira Rocha … Paulo Ernando Ferraz Cavalcanti Sérgio Tavares Montenegro

Abstract

Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events.

We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic.

In the reported case, the patient’s profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.

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ABCIC

Case Report

Giant Left Atrial Myxoma and Mitral Valve Obstruction: a Case Report

Lucas F. Cardoso et al. Elinthon T. Veronese Carlos Manuel de Almeida Brandão Pablo Maria Alberto Pomerantzeff … Carlos E. Rochitte Fabio B. Jatene

Abstract

Myxomas are rare entities that represent the majority of benign cardiac tumors in adults. Their clinical presentation may vary by dimension and location, and they can occur in asymptomatic individuals as an incidental finding of cardiac mass from imaging exams. This article reports the case of a female patient with no known comorbidities who was admitted to the emergency department with acute heart failure. Transthoracic echocardiography revealed a mass in left atrium corresponding to a giant myxoma partially occluding the mitral valve, which required urgent surgical intervention.

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ABCIC

Case Report

Left Atrial Myxoma Involving Multisystemic Manifestations in an Eldery Female Patient

Vanessa de Assis Reis et al. Bruno Oliveira Isabella Marcelo Loula Novais de Paula Ana Terra Fonseca Barreto

Abstract

Atrial myxomas may progress asymptomatically or present systemic manifestations. Echocardiography is an effective complementary exam to diagnose such pathology. Cardiac surgery represents the definitive treatment; particularly when performed early, it can avoid tumor growth–related complications. This article reports the case of an elderly high-risk cardiovascular patient admitted with acute ST elevation myocardial infarction in a cardiac unit progressing with cardiogenic shock, which contributed to the low suspicion of cardiac tumor as the initial diagnosis.

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ABCIC

Case Report

Third Recurrence of Cardiac Myxoma in a Carney Complex Patient

David Alejandro Salazar Jaya et al. Kevin Rafael de Paula Morales Félix Ramires Paulo Sampaio Gutierrez … Ricardo Ribeiro Dias Vagner Madrini Junior

Introduction

Primary cardiac tumors are an uncommon entity with an incidence of 0.3–0.7%. Most primary cardiac neoplasms are benign, with cardiac myxoma (CM) being the most prevalent type.^– Patients with CM may present symptoms due to embolic phenomena or intracardiac blood flow obstruction for which the treatment is surgical resection.^– Postoperative tumor recurrence occurs in up to 3% of cases; however, when myxomas are part of an underlying genetic syndrome, the recurrence rate can reach 22%. The main syndrome associated with this recurrence is the Carney complex (CNC). First described in 1985 by J. Aidan Carney, CNC is defined as an extremely rare autosomal dominant genetic syndrome with main clinical characteristics including skin pigmentation, heart myxomas, and endocrine neoplasms.

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ABC

Artigo Original

Magnetic resonance imaging evaluation of cardiac masses

Maria Fernanda Braggion-Santos et al. Marcel Koenigkam-Santos Sara Reis Teixeira Gustavo Jardim Volpe … Henrique Simão Trad André Schmidt

BACKGROUND: Cardiac tumors are extremely rare; however, when there is clinical suspicion, proper diagnostic evaluation is necessary to plan the most appropriate treatment. In this context, cardiovascular magnetic resonance imaging (CMRI) plays an important role, allowing a comprehensive characterization of such lesions. OBJECTIVE: To review cases referred to a CMRI Department for investigation of cardiac and paracardiac masses. To describe the positive case series with a brief review of the literature for each type of lesion and the role of cardiovascular magnetic resonance imaging in evaluation. METHODS: Between August 2008 and December 2011, all cases referred for CMRI with suspicion of tumor involving the heart were reviewed. Cases with positive histopathological diagnosis, clinical evolution or therapeutic response compatible with the clinical suspicion and imaging findings were selected. RESULTS: Among the 13 cases included in our study, eight (62%) had histopathological confirmation. We describe five benign tumors (myxomas, rhabdomyoma and fibromas), five malignancies (sarcoma, lymphoma, Richter syndrome involving the heart and metastatic disease) and three non-neoplastic lesions (pericardial cyst, intracardiac thrombus and infectious vegetation). CONCLUSIONS: CMRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, contributing to a more accurate diagnosis in a noninvasive manner and assisting in treatment planning, allowing safe clinical follow-up with good reproducibility.

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ABC

Case Report

Giant atrial myxoma mimicking severe mitral stenosis in young patient

Eric Paiva Vilela et al. Leonardo Moura Danielle Pepe Edson Nunes … Fabio Erthal Erika Campana

The echocardiogram of a twenty-year-old man, previously healthy, suffering from paroxysmal nocturnal dyspnea and fatigue after moderate exertion that intensified over a period of about ten days, showed the left atrium myxoma working as severe mitral stenosis.

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ABC

Case Report

Left atrial myxoma associated with obstructive coronary artery disease

Ronaldo Altenburg Odebrecht Curi Gismondi et al. Renato Kaufman Gabriel Ângelo de Cata Preta Correa César Nascimento … Luiz Henrique Weitzel José Oscar Brito Reis Antônio Sérgio Cordeiro da Rocha Ademir Batista da Cunha

We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

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ABC

Original Article

Primary neoplasms of the heart. Clinical and histological presentation of 50 cases

Fábio Fernandes et al. Helena N. Soufen Barbara M. Ianni Edmundo Arteaga … Félix J. A. Ramires Charles Mady

OBJECTIVE: To analyze clinical and histologic findings of 50 patients with primary neoplams of the heart in a tertiary referral center. METHODS: From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16±18 years). RESULTS: Most tumors were located in the left side of the heart (72%), myxoma being the most common (84%) histologic type. The other histologic types found were as follows: fibroma (4%), lipoma (2%), rhabdomyosarcoma (2%), hemangioma (2%), sarcoma (2%), angiosarcoma (2%), and lymphoma (2%). Diagnosis was established by echocardiography in 94% of the cases. Clinical findings were as follows: dyspnea (36%), weight loss (20%), palpitations (18%), chest pain (16%), fever (8%), and arthralgia (6%). All patients with thromboembolic phenomena (10%) had left atrial myxoma. Approximately 20% of the patients were asymptomatic at the initial clinical assessment. CONCLUSION: Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion.

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