The Etiology of Atrial Myxoma Tumor Plop

Abstract

A transthoracic echocardiogram detected an atrial myxoma (T) in the left atrium (LA) of a 39-year-old woman with a tumor plop heart sound (A and E). Onset of systole (A, left), midsystole (A, middle), and isovolumic relaxation (A, right) are depicted. With onset of diastole (B, left), a high-velocity jet (arrow) occurred when the tumor passed through the mitral orifice, partially occluding it. Jet velocity decreased in mid-diastole (B, middle) and increased with atrial contraction (B, right, asterisks). Both the high-velocity jet on continuous-wave Doppler (C) and the plop sound (P) on phonocardiography (D) occurred right after the second heart sound (S2) (Online Video 1). After excision, the tumor and associated plop were absent (F to J, Online Videos 2 and 3 for 3-dimensional echocardiographic comparison).This case suggests that the cause of the plop sound may relate to tumor obstruction of the mitral orifice with associated high-velocity flow, although this is difficult to distinguish temporally from other reported causes such as sudden tensing of the tumor stalk or impact of the tumor against the septum. LA ϭ left atrium; LV ϭ left ventricle.

Medical management of a suspected atrial myxoma in a nonagenarian

“…Dyspnea and palpitations were the most common symptoms on index presentation, being 70% and 35%, respectively. 14 Our patient had atrial fibrillation, which was coincident in almost 30% of patients. 5 , 15 The emergence of heart failure is contingent on tumor location and burden in creating a pseudo-stenotic effect due to malapposition of mitral valve leaflets and obstructive physiology within the left ventricular outflow tract.…”

<p>Atrial myxoma presenting as a non-ST-segment elevation myocardial infarction</p>

“…There was a possible element of intracardiac obstruction resulting in mild heart failure symptomatology and angina from suspected embolization without overt constitutional symptoms. She did not report trepopnea preceding her admission, nor was there any evident “tumor plop” auscultated during the physical examination 8,9. A case series of 112 myxoma patients describes 65% of patients as having cardiac auscultatory abnormalities with only 15% displaying the characteristic “tumor plop.” Left atrial hypertrophy on electrocardiogram accounted for the most frequent electrocardiographic abnormality in 35% of patients, whereas in our patient a sinus tachycardia with a right bundle branch block was present 6…”

A Multiple Myxoma in Right Ventricle and Right Atrium

“…Laboratory abnormalities (e.g., anemia and elevations in the erythrocyte sedimentation rate, Creactive protein, or globulin level) are present. 8,9 Screening for myxoma is important in cases of family history, in complex myxoma, or Carney disease. Our patient present with the feature of right heart failure and the diagnosis was made by echocardiography.…”