Prolapsing left atrial myxoma: preoperative diagnosis using a multimodal imaging approach with magnetic resonance imaging and real-time three-dimensional echocardiography

Abstract

According to the guidelines of the European Society of Cardiology on the diagnosis and management of pericardial diseases, tissue Doppler imaging (TDI) is proposed to be part of the diagnostic work-up in patients with suspected constrictive pericarditis (CP). We describe a case which illustrates that TDI analysis may be misleading in patients with severe pericardial calcifications of the lateral mitral annulus. Multi-slice computed tomography (MSCT) data in this case contributed much to a better understanding of the impact of heterogeneous calcification patterns on the results of TDI assessment in CP.

Cardiac tumors and sources of embolism

“…Myxomas can occur in hereditary syndromes, but 93% are nonhereditary myxomas. Typically, patients are referred to echocardiography after a cerebral or peripheral embolic event; in rare cases, patients show clinical signs of valvular obstruction [35] which can be verified by color Doppler as demonstrated in the example of a giant left atrial myxoma shown in . Fig.…”

“…Usually connected to the endocardium by a pedicle, myxoma can also occur with a broad base. RT3DE has been demonstrated to provide accurate anatomic visualization as well as improved identification of the spatial relation of a myxoma to the interatrial septum [35][36] [37]. Butz et al [35] described an improvement in evaluation of obstructive effects on ventricular in-or outflow by using RT3D TEE.…”

“…RT3DE has been demonstrated to provide accurate anatomic visualization as well as improved identification of the spatial relation of a myxoma to the interatrial septum [35][36] [37]. Butz et al [35] described an improvement in evaluation of obstructive effects on ventricular in-or outflow by using RT3D TEE. Myxomas captured in 3D datasets can be sliced tomographically to identify structural patterns, including cysts, necrosis, hemorrhage, or calcification, which can be characteristically found inside myxomas.…”

“…Although initial reports demonstrated RT3D TTE to be useful in the identification of myxoma [36], a recent report of RT3D TEE assessment has shown superior visualization of tumor characteristics and identification of spatial relationships [35], which can be important when planning the surgical procedure [38|.…”

Papillary fibroelastoma prolapsing into the left ventricular outflow tract

“…To prevent such complications, tumor identification and surgical excision are essential. The prolapsing of the tumor into the left ventricular outflow tract with consecutive obstruction is a very rare finding [5,6]. The echocardiographic findings should be confirmed by histopathology, because of several clinical differential diagnoses including myxoma, lipoma, vegetation, and thrombi.…”