Neovascularized Myxoma‐Causing Abnormal Blood Flow in the Left Atrium Diagnosed by Transesophageal Echocardiography

Abstract

Myxomas are the most common primary cardiac tumor, and neovascularization of cardiac myxoma has been shown in previous case reports. However, it is seldom reported that abnormal blood flow spurted from a neovascularized myxoma into the cardiac chamber. In this unusual case report, we present a left atrial myxoma in a 44-year-old woman with atypical angina. Transesophageal echocardiography (TEE) revealed several small blood streams spurting from the surface of massively vascularized myxoma into the left atrium. Coronary angiography showed a feeding artery which arose from the right coronary artery and supplied the left atrial myxoma, with no evidence of coronary artery stenosis. This case demonstrated that TTE might be helpful for confirming the neovascularization of myxoma in the left atrium and finding the abnormal blood flow that spurts from the neovascularized myxoma. We speculate that the abnormal blood flow spurting from the neovascularized myxoma into the left atrium may have caused a coronary steal phenomenon thus resulting in myocardial ischemia.

A Giant Left Atrial Myxoma Neovascularized from the Right Coronary Artery

“…Only a few patients with giant left atrial myxoma supplied from RCA were demonstrated [ 4 – 6 ]. Our patient, presenting with obscure symptoms, is a rare case of a giant left atrial myxoma, which was shown with contrast dye on RCA angiogram.…”

Hemorrhage and associated fistula formation in a left atrial myxoma causing coronary artery steal syndrome

“…It offered us clearly dynamic changes seen in the color doppler image. Although we failed to discover the feeding artery and the fistula drainage site by TEE, it could give us some helpful indication for the abnormal blood flow of the tumor . Nevertheless, since exercise testing would involve risks such as embolism and left ventricular inflow disturbance, CAG is recommended prior to surgery in patients with chest symptoms…”

“…In conclusion, we reported a case of a vascularized left atrial myxoma with internal hemorrhage and associated fistula formation, which led to coronary artery steal syndrome and with subsequent resolution after resection of the mass and ligation of the feeding arteries. This case indicates that TEE is helpful for confirming the neovascularization of myxoma and detecting of potential coronary artery‐left atrial fistula.…”

“…Although we failed to discover the feeding artery and the fistula drainage site by TEE, it could give us some helpful indication for the abnormal blood flow of the tumor. 5 Nevertheless, since exercise testing would involve risks such as embolism and left ventricular inflow disturbance, CAG is recommended prior to surgery in patients with chest symptoms. 4 In conclusion, we reported a case of a vascularized left atrial myxoma with internal hemorrhage and associated fistula formation, which led to coronary artery steal syndrome and with subsequent resolution after resection of the mass and ligation of the feeding arteries.…”