We report case of a female patient who, over a series of months, presented pulmonary manifestation associated with nonspecific systemic symptoms and resulting in several hospitalizations with the diagnostic hypothesis of pulmonary fibrosis until the completion of an echocardiographic study that showed a large pedunculated left atrial myxoma prolapsing through the mitral valve for the left ventricle. In quite unfavorable clinical conditions, the patient was sent to our Service for surgical treatment, evolving during the preparation for surgery with acute pulmonary edema and hemodinamic instability and being submitted to a successfully surgery of emergency for resection of the tumor. The patient is asymptomatic.Descriptors: Myxoma. Heart neoplasms. Heart atria.Resumo É descrito caso de paciente do sexo feminino que apresentava manifestações pulmonares e sistêmicas inespecíficas há vários meses, as quais resultaram em várias internações hospitalares com a hipótese diagnóstica de fibrose pulmonar. Estudo ecocardiográfico evidenciou a presença de grande mixoma pediculado no átrio esquerdo, que prolapsava, através da valva mitral, para o ventrículo esquerdo. Em condições clínicas bastante desfavoráveis, a paciente foi encaminhada ao nosso Serviço para tratamento cirúrgico, evoluindo durante o preparo pré-operatório com edema agudo pulmonar e instabilidade hemodinâmica, sendo submetida a cirurgia de emergência, com sucesso, para ressecção da tumoração. A paciente encontra-se assintomática.Descritores: Mixoma. Neoplasias cardíacas. Átrios do coração. 284MOTTA, AAR ET AL -Cardiac surgery of emergency for resection of left atrial myxoma Bras Cir Cardiovasc 2008; 23(2): 283-287 Rev

Entre outubro de 1987 e julho de 1994, foram operados, em nosso Serviço, (Clínica Cárdio-Cirúrgica de Juiz de Fora) 3 pacientes portadores de mixoma do átrio esquerdo. A idade variou de 20 a 35 anos, com média de idades de 29,6 anos, e o sexo feminino representou 66,6% dos casos. A ocorrência de palpitações taquicárdicas foi relatada por todos os pacientes (100%), seguindo-se dispnéia de esforço, desconforto precordial e episódios de tontura em 2 casos (66,6%). Manifestações inespecíficas como mal-estar, adinamia, anorexia e emagrecimento foram relatados por 1 paciente (33,3%). Nenhum paciente apresentou acidente embólico prévio. O diagnóstico da tumoração cardíaca foi realizado com auxílio da ecocardiografia bidimensional e do estudo hemodinâmico e a confirmação de mixoma foi dada pelo estudo histopatológico. Nas operações utilizou-se circulação extracorpórea e a atriotomia esquerda como via de acesso. Não houve complicações durante o ato cirúrgico e no pós-operatório os pacientes evoluíram de forma satisfatória; todos receberam alta hospitalar assintomáticos.
Between October 1987 and July 1994 three patients presenting left atrial myxoma underwent surgery in our Service _ Clínica Cárdio Cirúrgica de Juiz de Fora. Ages ranged from 20 to 35 years (average 29.6 years) and 66.6% of these cases were female patients. The occurrence of tachycardic palpitations was reported by all the patients (100%) following effort with dypnea, precordial discomfort and episodes of dizziness in two cases (66.6%). Non specific manifestations such as general uneasiness, prostration, anorexia and emaciation were reported by one patient (33.3%). None of the patients in this series presented previous embolic accident.The diagnosis of cardiac tumor was accomplished with the help of the two-dimensional echocardiography and the hemodynamic study. The confirmation of the myxoma was given by the histopathological study. Extracorporeal circulation was used in the surgeries and left atriotomy was used as an approach to the tumor. There were no complications during the surgery and post-operatively the patients evolved satisfactorily. All the patients were asymptomatic when discharged from the hospital

The accuracy of two-dimensional echocardiography in the detection of intracardiac masses was verified in 334 patients who underwent cardiac catheterization in our laboratory over 21 consecutive months. A complete two-dimensional echocardiographic (2DE) examination was performed a day before catheterization. The presence or absence of a mass was verified at surgery in 77 patients who successively underwent mitral or aortic valve replacement (51), left ventricular aneurysmectomy with or without myocardial revascularization (25), and resection of atrial myxoma (2). In 32 patients 2DE revealed the presence of a mass-left or right atrial thrombi in 12, left atrial myxoma in 2, left ventricular thrombi in 16, and endocardial vegetations in 2. The other 45 patients were free of intracardiac masses on 2DE. Anatomic verification at surgery revealed the presence of an intracardiac mass in 34 patients. In 30 (true positives) of these, 2DE revealed the mass as well, and in 4 (false negatives) the presence of a mass had not been identified by 2DE. In 2 patients (false positives) the predicted mass was not found at surgery. Absence of a mass was correctly predicted by 2DE in 41 patients (true negatives). Thus 2DE detected intracardiac masses with sensitivity of 88.2% and a specificity of 95.3%. We recommend that 2DE be performed in all patients prior to hemodynamic study and/or cardiac surgery to enable safer management of patients with intracardiac masses during cardiac catheterization and/or cardiac surgery.

The plasma levels and myocardial content of verapamil and its metabolites norverapamil, N-dealkylverapamil and N-dealkylnorverapamil were determined in 15 patients with valvular [3] or ischaemic [12] heart disease. The mean myocardial plasma concentration ratio (M/P) was 7.05 for verapamil, 11.45 for norverapamil, 8.93 for N-dealkylverapamil, and 11.33 for N-dealkylnorverapamil, with great interpatient variability. The highest M/P ratios of verapamil were generally found in patients with the lowest plasma levels, suggesting that saturable tissue uptake may occur.

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