Incidental Finding of a Left Atrial Myxoma During Emergency Surgery for Thoracic Aortic Dissection.

Abstract

THE INCREASED USE of perioperative transesophageal echocardiography in cardiac surgery has resulted in the discovery of unexpected and previously undiagnosed findings. It has been reported that the incidence of abnormal findings in patients undergoing transesophageal echocardiography is approximately 11% and includes patent foramen ovale, simultaneous valvular abnormalities, and cardiac masses. 1 Kihara C. Murata K. Wada Y. et al. Impact of intraoperative transesophageal echocardiography in cardiac and thoracic aortic surgery. J Cardiology. 2009; 54: 282-288 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar The authors believe that this was the first case report of the management of incidental finding of a left atrial mass during the transesophageal echocardiography examination of a patient who was undergoing emergency repair of a type-A aortic dissection. Unexpected findings on intraoperative transesophageal echocardiography may be difficult findings with which to deal in the setting of emergency surgery, especially when the patient is otherwise asymptomatic and the mass is an incidental finding. While it may seem straightforward to remove a small but potentially harmful intracardiac mass, there are inherent risks with the procedure due to the additional effort, time, and complication rate. Moreover, there are no randomized, controlled clinical trials to guide the decision as to whether the incidental atrial myxoma should be removed in these patients. In this case, the finding of a large atrial mass altered the surgical plan in a positive way and directly impacted the long-term outcome for the authors’ patient.