Mixoma em átrio esquerdo associado a doença arterial coronariana obstrutiva

Abstract

Myxoma; heart atria left; coronary disease. block, left anterior hemiblock, and secondary alterations of ventricular repolarization. Chest radiography showed lung hyperinflation and a normal cardiac silhouette. Transesophageal echocardiography showed a 4.7 x 1.7-cm mobile mass in the left atrium that was non-obstructive at Doppler. Its origin could not be visualized, but there seemed to be a pedicle originated in the right upper pulmonary vein (Fig. 1).Myxomas are the most common type of cardiac tumors, accounting for 50% to 60% of the total in some case series, with an estimated incidence between 0.5 and one case per one million inhabitants-year 1 . The most common symptoms include dyspnea, atypical chest pain, and obstructive and embolic phenomena. Cases of sudden death have already been described, probably related to embolization to the coronary circulation 2 . Concomitant presence of coronary artery disease has been rarely described. The objective of this study is to report the case of a patient with left atrial myxoma and obstructive coronary lesions indicating the need of a coronary artery bypass grafting. Case ReportSixty-seven-year-old male patient with hypertension, dyslipidemia, chronic obstructive pulmonary disease and past history of smoking and acute myocardial infarction in 2000, treated with angioplasty without stenting of the anterior descending and right coronary arteries at the time. During preoperative assessment for an inguinal hernia repair, he underwent a transthoracic echocardiography that evidenced a tumor mass in the left atrium compatible with myxoma, and was referred to our institution for therapeutic management.In the initial assessment, the patient was asymptomatic, with a normal physical examination. Electrocardiogram showed a sinus rhythm with complete left bundle branchWe describe the case of a 67-year-old male patient with obstructive coronary artery disease who, in the preoperative assessment for an inguinal hernia repair, had undergone an echocardiography that showed a large, mobile, nonobstructive tumor in the left atrium, with a pedicle originated in the right superior pulmonary vein. The patient underwent a coronary angiography with left ventriculography that showed severe stenosis in the mid-third of the left anterior descending artery, moderate stenosis in the proximal third of the circumflex artery at the origin of the first marginal branch, and a non-obstructive lesion in the distal third of the right coronary artery. Moderate left ventricular dysfunction was also observed. The patient then underwent resection of the tumor and coronary artery bypass grafting. The histopathological examination revealed a myxoma. Considering the past history of infarction and the patient's age, we decided to perform a preoperative coronary angiography that showed no lesions in the trunk, a severe lesion at the mid-third of the anterior descending artery, a moderate lesion in the circumflex artery at the origin of the first marginal branch, albeit with a thin irregular distal bed, and a non...

Left atrial myxoma combined with coronary artery disease in an elderly patient

“…The prevalence of coronary atherosclerotic disease in patients with myxoma ranges between 20.3% and 36.6% [6][7][8][9]. In this report the patient had coronary artery disease according to coronary angiography 3 years ago.…”

Left atrial myxoma complicated with multi-system embolization

“…Myxomas related emboli in the coronary vasculature are uncommon, but when present, they may cause fatal myocardial infarctions (MI) [ 15 ]. A previous review documented that inferior myocardial infarctions have been seen in 63.6%,anterior in 22.7%, and posterior in 9.1% secondary to myxomas embolization [ 16 ]. Patients with myocardial infarction and concomitant myxomas often constitute a complex puzzle to put together and all clinical and imaging modalities must be used to plan and implement the best therapeutic strategy [ 17 ].…”