Biatrial Myxoma: A Case Report and Review of the Literature

Irani, Adel D.; Estrera, Anthony L.; Buja, L. Maximilian; Safi, Hazim J.

doi:10.1111/j.1540-8191.2007.00545.x

Cited by 28 publications

(24 citation statements)

References 28 publications

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“…However, thrombus simultaneously present in both atria is quite rare, although it seems to carry a high risk of embolic event [1]. In the present case, it was somewhat difficult to accurately diagnose the mass in the right atrium [2], although it is quite common to consider such a huge mass in the LAA extending to to left atrium as being thrombus. Right atrial thrombus could be derived from deep vein thrombus, malignancy, infective endocarditis, and coagulopathy.…”

Section: Discussionmentioning

confidence: 93%

Unusual biatrial thrombus in mitral stenosis

et al. 2010

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A 77-year-old man was admitted to our hospital with mild shortness of breath on exertion. For several years, he has been diagnosed as having mitral stenosis and complicating chronic heart failure. On physical examination his blood pressure was 125/75 mmHg with irregular pulse. ECG showed atrial fibrillation at a rate of 80-95 beats/min. Although he was given anticoagulant such as warfarin, the international normalized ratio (INR) of 1.2-1.4 was not sufficient. Brain computed tomography (CT) results were suggestive of old cerebral infarction, although thoracoabdominal CT did not show any signs of embolism in other organs. Transthoracic echocardiogram documented severe mitral stenosis with a valve area of 0.7 mm 2 and incidentally revealed abnormal mass-like image features in both atria. The tricuspid valve had mild regurgitation without stenosis. Calculated right ventricular systolic pressure was estimated to be 35 mmHg, suggesting the presence of mild pulmonary hypertension. Transesophageal echocardiography (TEE) confirmed the presence of a huge thrombus-like image feature (40 9 19 mm) in the left atrial appendage (LAA) extending to the dilated left atrium (Fig. 1a). Under these conditions, LAA emptying velocity was significantly reduced. Interestingly, another mobile mass image feature (25 9 20 mm) was detected in the lateral wall of dilated right atrium (Fig. 1b), and was considered to be tumor such as lipoma. The patient underwent mitral valve replacement and removal of biatrial abnormal masses, which were finally diagnosed as huge thrombi by pathological examination (Fig. 2a, b). DiscussionThrombus in the cardiac chamber is frequently associated with atrial fibrillation and valvular heart diseases. However, thrombus simultaneously present in both atria is quite rare, although it seems to carry a high risk of embolic event [1]. In the present case, it was somewhat difficult to accurately diagnose the mass in the right atrium [2], although it is quite common to consider such a huge mass in the LAA extending to to left atrium as being thrombus. Right atrial thrombus could be derived from deep vein thrombus, malignancy, infective endocarditis, and coagulopathy. However, the present right atrial thrombus should be primary thrombus associated with atrial fibrillation with inadequate anticoagulation, because there was no evidence for associated clinical manifestations regarding these complications.

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Section: Discussionmentioning

confidence: 93%

Unusual biatrial thrombus in mitral stenosis

et al. 2010

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“…Imperio et al reported that biatrial myxomas had two stalks arising from the same area of the interatrial septum and growing in opposite directions toward the right and left atria [6]. Irani et al reported that there was no evidence of extension across the interatrial septum, thereby favoring contemporaneous origin of two separate tumors [3], whereas Ha et al described two distinct types of myxoma, that is, a round type, characterized by a solid texture and round shape with a non-mobile surface (52%); and a polypoid type, characterized by a soft texture and an irregular shape with a mobile surface (48%) [7]. Right-sided myxomas are rare, but typically attach on a broad base and are more likely to be calcified than left-sided lesions [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…Over 70% of all cardiac myxomas originate from the left and 18% from the right atrium. Biatrial myxomas account for less than 2.5% of all cardiac myxomas [3-5]. We present biatrial myxoma, which occupies both atria without pedunculating mass.…”

Section: Introductionmentioning

confidence: 98%

Giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava

Choi

Park

Kim

et al. 2013

J Cardiothorac Surg

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Cardiac myxomas are the most common type of benign cardiac tumors and most of them occur in the left atrium but the biatrial myxoma is uncommon. We present a rare case of giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava. A 58-year old woman presented with exertional dyspnea and intermittent chest discomfort. The non-pedunculated tumor involved most of the interatrial septum and extended from the orifice of the inferior vena cava to the displaced mitral annulus and the lower left pulmonary vein. The resected specimen weighed 76 gram and measured 80 × 40 × 30 mm. She did not complain of dyspnea or show any sign of recurrence by echocardiography during the 2-year follow-up period.

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“…The vast majority (75-83%) occur in the left atrium, a very small percentage (1.3-2.5%) of myxomas are in both atria, most patients are women (56-64%), and embolic symptoms can occur (16-40%) [1][2][3][4]. To date, the only case of pulmonary embolism occurring in the presence of a left atrial myxoma involved the tumor crossing a large type II atrial septal defect [5].…”

Section: Introductionmentioning

confidence: 94%

Left atrial myxoma presenting as pulmonary embolism

Redford

Thompson²,

McCulloch

et al. 2014

Blood Coagulation &Amp; Fibrinolysis

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We present the case of a patient with left atrial myxoma that presented with pulmonary embolism. The patient did not have any intracardiac communication between right and left sides of the heart. Using thrombelastography, the patient was determined to have an abnormally large velocity of plasma thrombus growth and strength with reduced vulnerability to lysis. Critically, increased carboxyhemoglobin concentrations were present, likely secondary to hemolysis from the tumor and engagement of systemic heme oxygenase-1. It was determined that the patient's plasmatic hypercoagulability was in part due to carboxyhemefibrinogen formation via a thrombelastographic method. In addition to circulating hypercoagulability, the patient also had an area of chronic venous stasis in his left ankle that had not changed for over a decade prior to this thrombophilic episode. In conclusion, we present the first case of paradoxical pulmonary embolism in the presence of a left atrial myxoma, potentially secondary to a combination of hemolysis, heme oxygenase-1 up-regulation, systemic hypercoagulability/hypofibrinolysis, and regional venous stasis.

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Biatrial Myxoma: A Case Report and Review of the Literature

Abstract: Biatrial myxoma is a very rare condition, with diagnostic challenges, but is amenable to modern surgical approaches.

Cited by 28 publications

References 28 publications

Unusual biatrial thrombus in mitral stenosis

Unusual biatrial thrombus in mitral stenosis

Giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava

Left atrial myxoma presenting as pulmonary embolism

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