Ping-Pong Mitral Stenosis: Left Atrial Myxoma With Mitral Stenosis and Pulmonary Hypertension in an Octogenarian

Abstract

Left atrial (LA) myxoma presenting with symptoms of mitral stenosis in elderly males is very rare accounting for 10% of the cases. We report an 80-year-old male who presented with symptoms of orthopnea and palpitations and was subsequently found to have a large LA myxoma obstructing the mitral valve and causing pulmonary hypertension (PHT).

Atrial Myxoma Mimicking Mitral Stenosis

“…Myxomas are easily misdiagnosed and should be considered in the differential diagnosis in patients with suspected mitral valve disease [ 1 , 3 ]. Echocardiography should be performed as early as possible to establish a prompt diagnosis and management [ 6 ].…”

“…Myxomas can cause a pulmonary or systematic embolism, depending on the position of the tumor in the heart [ 2 ]. It can cause obstruction in the blood flow, mimicking mitral stenosis like in our case or mitral regurgitation as a result of complete blockage of the valve [ 3 , 4 ]. Non-specific symptoms like fever, weight loss, and fatigue have also been reported [ 2 ].…”

An unusual cause of heart failure in a young female: a case of massive left atrial mxyoma

“…Heart failure in the context of a large right atrial myxoma has been described in the literature, and in each case the patient had symptoms of 5 months and 4 weeks before diagnosis 8,9 . Left sided atrial myxomas can result in obstruction of blood flow through the mitral valve, mimicking mitral stenosis or mitral regurgitation—as in our case 10 . A large left atrial myxoma mimicking mitral stenosis was also reported in a patient with multiple syncopal episodes and severe exertion presenting with acute pulmonary edema 11 …”

“…8,9 Left sided atrial myxomas can result in obstruction of blood flow through the mitral valve, mimicking mitral stenosis or mitral regurgitation-as in our case. 10 A large left atrial myxoma mimicking mitral stenosis was also reported in a patient with multiple syncopal episodes and severe exertion presenting with acute pulmonary edema. 11 Interestingly, although atrial myxomas are associated with embolic phenomena and death, the patient had a period of 6 months without diagnosis, but did not develop any adverse sequelae related to the condition.…”

A Rare Cause of Pulmonary Hypertension and Right Ventricular Failure: Left Atrial Myxoma

“…However, pulmonary hypertension, severe RV systolic dysfunction, and tricuspid regurgitation are less commonly recognized sequelae. 4 , 5 , 6 , 7 …”