Cirurgia cardíaca de emergência para ressecção de mixoma atrial esquerdo

Abstract

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

Giant Right Atrial Mixoma With Important Hemodynamic Repercussion in Child

“…1,[5][6][7][8] These tumors have a higher incidence in women between the third and fourth decade of life and are rare in children. 1,4 They are usually pedunculated, sporadic and solitary tumors, but when associated with rare familial forms of cardiac myxomas, they preferentially affect younger individuals and may present in a multicentric form in up to half of the cases. 1,[7][8] The growth of tumor mass in sporadic forms may range from 1.3 to 6.9 mm/month, measuring 5 cm on average, and their average weight is 37g, reaching up to 180g.…”

“…3 However, although the tumor has benign characteristics the symptomatology will depend on the size, shape, mobility and location of the tumor. 1,3,4,8 When present, their manifestations are diverse and nonspecific, making a differential diagnosis with other heart diseases or systemic diseases. 1,3 Symptomatic cardiac myxoma patients present with at least one of the characteristics of a classically described triad, which includes: the hemodynamic consequences of intracardiac obstruction, embolic events, and nonspecific constitutional or systemic symptoms.…”

“…1,3 Symptomatic cardiac myxoma patients present with at least one of the characteristics of a classically described triad, which includes: the hemodynamic consequences of intracardiac obstruction, embolic events, and nonspecific constitutional or systemic symptoms. [3][4][5]8 The most common manifestations are dyspnea, atypical chest pain and syncope. 8 They may also present cardiac arrhythmias due both to direct infiltration of cardiac conduction tissue or to myocardial irritation.…”

“…Symptoms may range from episodes of dyspnea, arrhythmias (mainly atrial fibrillation), palpitations, chest discomfort, dizziness, syncope, heart failure, acute pulmonary edema and sudden death. 3,4 In younger and male patients, neurological symptoms tend to be more evident, while in female patients the systemic symptoms tend to be more expressive. 3 The right atrial myxoma can obstruct the tricuspid valve, causing symptoms of right heart failure, peripheral edema, hepatic congestion and syncope, as evidenced in the case reported.…”

“…The rapid diagnosis and surgical treatment provide a favorable prognosis for patients with these tumors. 4 We present here the case of a child admitted to the Hospital Infantil Público de Palmas (HIPP), with a history of abdominal distension, adynamia, hyporexia and intermittent fever, initially diagnosed with right atrial myxoma.…”