Giant Myxoma Research Articles

Giant myxoma of the right sections of the heart obstructing the inferior vena cava: A case report

Objective: We present a rare case of surgical management of giant myxoma of the right heart with obstruction of the orifice of the inferior vena cava (IVC), obstruction of the right atrioventricular orifice, with the development of high pulmonary hypertension, and severe heart failure. Case presentation: A 39 years old male patients applied to the consultative polyclinic with typical complaints of severe shortness of breath, palpitations, severe weakness, almost bed rest, severe swelling of the lower extremities, with a transition to the anterior abdominal wall (edema). On physical examination signs of severe heart failure NYHA class IV were revealed. Imaging demonstrated giant right atrial myxoma obstructing IVC with base originated in fossa ovalis, obstructing tricuspid valve and protruding in the right ventricle occupying 50% of its cavity. The surgical removal of the giant RA myxoma protruding the right ventricle and obstructing IVC and tricuspid valve was performed under cardiopulmonary bypass and hemodynamic support. The patient was discharged on the 10th day after surgery and only residual minimal tricuspid regurgitation was revealed on follow-up examination. Conclusion: The described case from our practice proves the possibility of a severe course of giant myxomas of the right heart, with the development of deep hemodynamic complications of systemic and pulmonary circulation. The chosen correct tactics of surgical treatment provided a favorable result, despite the severity of the initial condition and the degree of hemodynamic disturbance. Intraoperative tactics and technique for performing the stages of urgent surgery were chosen based on the situation, the features of the anatomical structure of the tumor, and the severe complications that arose. Our case proves the possibility of adequate implementation of such interventions, when choosing the right tactics of surgical treatment. Take home message: If clinical signs of circulatory failure, heart failure are detected, it is necessary to perform echocardiography. If mass formations of the heart chambers are detected, immediately refer the patient to specialized cardiac surgery clinics to resolve the issue of surgical correction of pathology.

Giant Myxoma of the Right Atrium a Rare Location: A Case Report at the Festoc Center in Bamako

Right ventricular myxoma is a very rare location of cardiac myxomas. The most common complications are pulmonary embolism and tumor obstruction of the pulmonary valve. We report the case of a 63-year-old woman admitted to Cardiology for recurrent syncope and progressively worsening dyspnea. Echocardiography revealed right atrial myxoma. Surgical excision was performed under extracorporeal circulation, with favorable postoperative outcomes. Histological examination of the specimen confirmed the diagnosis of myxoma. The 2-month follow-up does not show any tumor recurrence.

Giant myxoma removal through a 3D-4K minimally invasive thoracoscopy: a case report and step-by-step guide

Video 1 Intraoperative record showing removal of the giant myxoma from the opening of pericardium up to the placement of the epicardial lead for pacing.

Huge left atrial myxoma: about 2 cases resected in the Democratic Republic of Congo

BackgroundMyxoma is the most common cardiac tumor, found in 75–80% of cases in the left atrium. It can grow quietly and therefore reach a large size before being symptomatic. Poor availability of echocardiography also contributes to delayed diagnosis. In Sub-Saharan African countries, myxoma diagnosis can be missed for many patients. Myxoma resection surgery, although technically simple, is not always possible, because of the lack of cardiac surgery development. The aim of this report is to describe the first two consecutive resection cases of huge left-atrial myxoma performed in Kinshasa, Democratic Republic of Congo (DRC) and to discuss the specificities of this surgery in this low-resource context.Case presentationTwo patients, 54 and 48 years old, were diagnosed with giant myxoma of the left atrium in the management of progressive dyspnea The first patient's transthoracic echocardiography revealed a pedunculated atrial mass (37 × 48 mm) on the interatrial septum, passing through the mitral valve. For the second patient, the mass (64 × 26 mm) was attached to the roof of the left atrium and protruded into the mitral valve, with significant mitro-tricuspid regurgitation The first patient underwent a simple resection of the myxoma. For the second patient, it was associated to a mitro-tricuspid annuloplasty. The postoperative course was simple for the first patient, but the second patient developed a biventricular failure requiring vasoactive drugs. Both patients were discharged alive from the hospital on postoperative days 10 and 12, respectively. They are regularly followed up and are doing well 2 years after surgery.Discussion and conclusionSurgical resection is the only effective treatment of myxoma. Our first results are encouraging The poor availability of the echocardiography is a challenge in the diagnosis of myxoma. The development of cardiac surgery in DRC and ongoing country-level efforts to address diagnostic challenges for these often silent tumors will allow us to expect more resections to be performed locally and larger series published.

P55 A CHALLENGING RIGHT ATRIAL MASS

Abstract A 64–year–old woman presented at the Emergency Department with worsening dyspnoea and fever. Blood tests revealed normal white blood count, elevated C–reactive protein (244 mg/L) and D–dimer (2618 ng/mL). At arterial blood gases test hypoxaemia and hypocapnia was found (pH 7.48, pO2 83 mmHg, pCO2 30 mmHg, base excess –1.2 mmol/L, lactates 1.0 mmol/L). She underwent thoracic computed tomography (CT), which showed right inferior pulmonary embolism with infarction. A transthoracic echocardiography (TTE) revealed the presence of a mobile heterogeneous iso–hyperechoic neoformation completely occupying the right atrial cavity and moving partially across the tricuspid valve (Figure 1). A right atrial thrombotic formation was hypothesized and, due to its dimension, despite a valid hemodynamic, the patient underwent thrombolysis with rtPA 100 mg iv infusion over 2 hours. However, the next day at CT and TTE the mass was still there and unmodified. The screening for thrombophilia and for cancer markers were negative. Cardiac magnetic resonance imaging was waived because the clinical conditions were rapidly deteriorating. Indeed, the patient was transferred for urgent cardiac surgery. The excised mass was 5 cm x 3.5 cm large and adherent to the right atrial roof, 1 cm close to the atrioventricular node. It was completely removed by the cardiac surgeon (Figure 2). The subsequent journey was regular, without complications. The histologic exam revealed that the mass was a giant myxoma (Figure 3). At follow–up the patient persisted asymptomatic. Figure 1. Transthoracic echocardiography. Figure 2. The excised right atrial mass. Figure 3. Histologic examination of the right atrial mass.

Intraoperative record showing removal of the giant myxoma from the opening of pericardium up to the placement of the epicardial lead for pacing

Intraoperative record showing removal of the giant myxoma from the opening of pericardium up to the placement of the epicardial lead for pacing

Multidisciplinary management of a giant and obstructive laryngeal myxoma

Multidisciplinary management of a giant and obstructive laryngeal myxoma

P234 Giant right atrial myxoma presenting as right heart failure

Abstract Introduction Myxomas are the most frequent primary cardiac neoplasms. It is currently believed that myxomas are derived from multipotent mesenchymal cells capable of both neural and epithelial differentiation Histologically, these tumors are composed of dispersed cells within a stroma of mucopolysaccharides Myxomas produce vascular endothelial growth factor, which probably contributes to the growth induction at the initial stages of tumor growth. Tumors vary widely in size, ranging from 1 to 15 cm in diameter and weighing between 15 and 180 g. About 35 percent of myxomas are friable, and they tend to present emboli. The clinical characteristics of these tumors are closely related to their location, size, and mobility; there are no specific signs and symptoms that suggest the presence of a myxoma. There are several mechanisms by which cardiac tumors can cause symptoms. The blockage of circulation through the heart or heart valves produces symptoms of heart failure. Atrial myxoma can interfere with the valves of the heart and cause regurgitation. They can also produce systemic embolisms and constitutional signs. Clinical Case We present a 29-year-old female patient who started with fatigue, weight loss, increased abdominal perimeter and dyspnea of one month"s effort that progressed to dyspnea at rest in the last week associated with syncope, so she decided to go to the emergency department of our institution. Upon arrival at the emergency room, the patient was found with vital signs within normal parameters, however with dyspnea at rest, jugular plethora and important lower limb edema. On auscultation, a systolic-diastolic murmur was found with an increase in the Rivero Carvallo maneuver, with reinforcement of the pulmonary component of the second noise and parasternal high-left rise. In clinical analysis, NT-proBNP 5698pg/mL, AST 34, INR 1.65 and serum lactate of 4.2 was found. A Transthoracic Echocardiogram (TTE) was performed, where a 10cm mass effusion was documented that occupied the entire right atrium and protruded into the right ventricular outflow tract. With these findings, medical treatment was started for right heart failure and it was to cardiac surgery for resection of the right atrium where it had been performed, however during the immediate postoperative state, presented biventricular failure and later asystole without achieving a return of spontaneous circulation despite resuscitation maneuvers. Conclusion In this case, it is an unusual presentation of a rare cardiac pathology that started with symptoms of right heart failure due to the obstruction of the right ventricular outflow tract. We consider that it is an interesting clinical case and with important educational aspects to take into consideration the differential clinical diagnoses of a patient presenting to the emergency department with right heart failure. Abstract P234 Figure. Giant Myxoma

Giant Intrapericardial Myxoma Adjacent to the Left Main Coronary Artery

A 62-years-old woman was admitted to the hospital because of chronic cough, expectoration of thick mucus, hoarseness and tightness in the precordial area. Computed Tomography (CT) examination revealed the presence of a giant intrapericardial tumor with the dimensions of 80 × 38 × 32 mm. It was located anteriorly and laterally to the left atrium, posteriorly to the pulmonary trunk and the ascending aorta. This hypodense change modeled the left atrium without evidence of invasion. CT coronary angiography and 3-dimensional reconstruction were applied to enable precise planning of cardiac surgery. CT evaluation confirmed that it is possible to remove the tumor without damage to the adjacent left main coronary artery. The patient underwent cardiac surgery with sternotomy and cardiopulmonary bypass. A cohesive, smooth, vascularized tumor pedunculated to the left atrial epicardium was visualized. The location and dimensions corresponded to those determined by CT scan examination. The entire tumor was successfully dissected together with adjacent adipose and fibrous tissue. Histological evaluation revealed the presence of myxoid cells, blood vessels, degenerative changes, and microcalcifications embedded in profuse hyalinized stroma. Those histological features enabled identification of the intrapericardial tumor as a myxoma. Follow-up CT examination did not demonstrate any signs of recurrence of the myxoma. According to our knowledge, a myxoma located inside the pericardial sac has never been described before.

Giant obstructive myxoma presenting as mitral valve obstruction with severe pulmonary hypertension.

Cardiac myxomas may have different clinical presentations that may expose the patient to sudden death due to obstruction of the left ventricle inflow. The authors report a case of 34 years old male who was diagnosed with left atrial myxoma that presented as mitral valve obstruction with severe pulmonary hypertension. He underwent emergent sternotomy under cardiopulmonary bypass and the myxoma was successfully removed. The postoperative course was uneventful.

The case of diagnosis of the left and right atria giant myxomas

A rare case of the simultaneous left and right atria giant myxomas is reported in the article. A short review of epidemiologic, morphologic and genetic features of these benign tumors is submitted in the issue. The clinical manifestations of the disease are often presented with nonspecific symptoms, so myxoma are often late diagnosed. Timely detection of the heart myxomas allows a correct choice of surgical tactics and contributes to patients’ recovery.

Atypically mitral valve originated giant myxoma presenting with acute ST-segment elevation myocardial infarction and acute pulmonary edema

Kardiyak miksomalar %0,0017-0,03 insidansina sahip oldukca nadir olan bir hastalik olup en sik ucuncu ve altinci dekadlar arasinda gorulur. Olgularin %65’ini kadinlar olusturur. Olgularin %75’inde sol atriyumdan, %18’inde sag atriyumdan, %4’unde ise ventrikullerden koken alirlar. En nadir goruldukleri yer ise kapak dokulari olup siklik sirasi trikuspit kapak, mitral kapak, pulmoner kapak ve aortik kapaktir. Kapak kokenli miksomalari gercek insidansi belirsizdir. Klinik belirtileri sistemik semptomlar, emboliler ve intrakardiyak obstruksiyonlardan kaynaklanir. Gucsuzluk, ates, kilo kaybi, eklem agrilari sistemik semptomlardan bazilaridir. Tromboemboliler tumoral dokunun kendisinden kaynaklanabildigi gibi kitle uzerinde organize olmus pihtilardan da meydana gelebilmektedir. Dispne, ortopne, bas donmesi, senkop ve pulmoner odem intrakardiyak obstruksiyonlardan kaynaklanan semptomlardir ve lokalizasyon, boyut ve hareketlilige gore degiskenlik gosterebilir. Bu makalede dispne, gogus agrisi ve tasikardi ile prezente olan ve ST elevasyonlu miyokard enfarktusu, akut pulmoner odem, pulmoner hipertansiyon, paroksismal atriyal fibrilasyona yol acan mitral anuler ve posterior kapakciktan koken alan dev miksoma tanisi alan 77 yasinda bir kadin hastayi sunmayi amacladik.

Giant myxoma of the left atrium mimicking severe mitral valve stenosis and pulmonary hypertension

Les myxomes cardiaques sont les tumeurs primitives intracardiaques les plus frequentes de l’adulte avec une frequence de 0,5 par million d’habitants par an. Ils representent 50 % des tumeurs cardiaques. Quoique benins d’un point de vue histologique, leur localisation peut mettre en jeu le pronostic vital du patient. Leur symptomatologie insidieuse en rend souvent difficile le diagnostic jusqu’au stade de complications. Environ 50 % des patients porteurs de myxomes presentent des symptomes [...]

Primary giant myxoma of the temporal bone with major intracranial extension: presenting with hearing impairment and ear polyp

Abstract Myxomas are mesenchymal origin, benign tumor, constituting approximately half of the benign cardiac tumors. Occasionally, it may also occurs at other locations, though the intracranial location of a myxoma is considered exceptionally rare. Only isolated few cases of intracranial myxoma are reported in the literature, almost all were locally confined within the originating bone. The extensive Pubmed and Medline search yielded only eight cases of primary myxoma arising in the temporal bone with extension into intracranial compartment. However intracranial extension is limited as early detection, however, Osterdock et al reported a case also arising from temporal bone with extensive intracranial extension. Author report an interesting case of intracranial myxoma in 27- year- old- male, involving the temporal bone associated with extensive bony erosion and also extending into infratemporal fossa, mastoid, and frontoparietal region and a polypoidal mass protruding into external ear. To the best of knowledge of authors, temporal myxoma presenting with external ear polypoidal mass, which underwent successful surgical excision is not reported and represent first case in the world literature.

Left atrial giant myxoma resection with video-assisted minimally invasive method

Minimal invaziv kalp cerrahisi halen gelismekte olan bir tekniktir. Video destekli sag anterolateral mini torakotomi ile yapilan cerrahi en sik kullanilantekniklerdendir. Bu yazida 48 yasinda kadin hastada gecici iskemik atak sonrasinda tani konulan dev sol atriyal miksomanin video destekli minimalinvaziv yontemle cikartilmasi ve hastada olusan atriyal septal defekt ve mitral yetmezlik tamirlerinin hastaya ek ameliyat riski getirmeden ayni seanstayapilabilecegi gosterildi.

A giant myxoma of the left atrium involving the entirety of fossa ovalis: Clinical course, diagnosis and treatment

Myxomas are the most common primary cardiac tumors. These tumors have generated interest due to their variable clinical presentation. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications [ 1 Moreno Martínez F.L. Lagomasino Hidalgo A. Mirabal Rodríguez R. López Bermúdez F.H. López Bernal O.J. Recurrent left atrial myxoma. Arch. Cardiol. Mex. Oct-Dec 2003; 73: 280-283 PubMed Google Scholar , 2 Okamoto Y. Shimura K. Mitsumori Y. Katsu M. Kaga S. Inoue H. Ogata K. Suzuki S. Shindo S. Matsumoto M. Recurrent cardiac myxoma that developed rapidly in a short period. Kyobu Geka. Feb 2009; 62: 129-132 PubMed Google Scholar , 3 Santangeli P. Pieroni M. Marzo F. Frontera A. Vitulano N. Luciani N. Bellocci F. Crea F. Cardiac myxoma presenting with sensory neuropathy. Int. J. Cardiol. Aug 6 2010; 143: e14-e16https://doi.org/10.1016/j.ijcard.2008.12.038 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 4 Attar M.N. Sharman D.C. Al-Najjar Y. Moore R.K. Millner R.W. Khan S.X. A rare case of multiple right heart myxomas. Int. J. Cardiol. May 31 2007; 118: e66-e67 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 5 Parissis J.T. Zezas S. Sfiras N. Kastellanos S. An atypical left atrial myxoma causing intracavitary pressure gradient and typical diastolic transmitral flow of severe mitral stenosis. Int. J. Cardiol. Jun 22 2005; 102: 165-167 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 6 Imbalzano E. Dattilo G. Scarpelli M. Lo Gullo A. Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern. Emerg. Med. Dec 2013; 8: 765-766https://doi.org/10.1007/s11739-013-0996-9 Crossref PubMed Scopus (25) Google Scholar , 7 Yazici M. Norgaz T. Akdemir R. Albayrak S. Asymptomatic giant left atrial myxoma supplied from right coronary artery in a 65-year-old woman. Int. J. Cardiol. Jun 8 2005; 101: 495-496 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar , 8 Gogas B.D. Rallidis L.S. Iliodromitis E.K. Kremastinos D.T. Right atrial myxoma presenting as syncope due to pulmonary embolism in a previously asymptomatic patient. Int. J. Cardiol. Apr 14 2011; 148: e34-e36https://doi.org/10.1016/j.ijcard.2009.02.018 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar , 9 Acikel M. Yekeler I. Ates A. Erkut B. A giant left atrial myxoma: an unusual cause of syncope and cerebral emboli. Int. J. Cardiol. Apr 2004; 94: 325-326 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 10 Imbalzano E. Di Bella G. Casale M. Boretti I. Manganaro R. Lamari A. Dattilo G. Angina pectoris: first manifestation of a left atrial myxoma. Int. J. Cardiol. 2014; 172: e165-e166https://doi.org/10.1016/j.ijcard.2013.12.059 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , 11 Alexiou K. Wilbring M. Matschke K. Angina pectoris as first manifestation of a huge biatrial myxoma. Acta Cardiol. Oct 2009; 64: 667-668 Crossref PubMed Scopus (7) Google Scholar , 12 Patanè S. Marte F. Dattilo G. Sturiale M. Acute myocardial infarction and left bundle branch block with changing axis deviation. Int. J. Cardiol. Feb 9 2012; 154: e47-e49https://doi.org/10.1016/j.ijcard.2009.03.128 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar , 13 Braun S. Schrötter H. Reynen K. Schwencke C. Strasser R.H. Myocardial infarction as complication of left atrial myxoma. Int. J. Cardiol. May 11 2005; 101: 115-121 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 14 Panos A. Kalangos A. Sztajzel J. Left atrial myxoma presenting with myocardial infarction. Case report and review of the literature. Int. J. Cardiol. Oct 31 1997; 62: 73-75 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar , 15 Patanè S. Marte F. Sturiale M. Dattilo G. Changing axis deviation and acute myocardial infarction. Int. J. Cardiol. Aug 18 2011; 151: e1-e3https://doi.org/10.1016/j.ijcard.2009.03.013 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 16 Milicevic G. Gavranovic Z. Cupic H. Cerovec D. Stipic H. Jukic M. Letica D. Predrijevac M. Unremitting embolus from cardiac myxoma at circumflex artery trifurcation. Int. J. Cardiol. Jun 6 2008; 126: 424-426 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 17 Tulino V. Cacace C. Tulino D. Imbalzano E. Dattilo G. Clinical variants in Ebstein's anomaly. Int. J. Cardiol. Oct 12 2013; 168: 4969-4970https://doi.org/10.1016/j.ijcard.2013.07.138 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar , 18 Kolvekar S.K. Keal R. Spyt T. Unusual presentation of an atrial septal aneurysm with left atrial myxoma: a case report. Int. J. Cardiol. Apr 18 1997; 59: 197-198 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ].

Case-based session: cardiac masses: Wednesday 3 December 2014, 11:00-12:30 * Location: Agora

Case-based session: cardiac masses: Wednesday 3 December 2014, 11:00-12:30 * Location: Agora

Rapid valve prosthesis deterioration coupled with recurrent giant myxoma in a young asymptomatic adult

An 18-year-old female with no past cardiovascular history was admitted to the emergency room due to dyspnoea, reduced exercise tolerance, and mild systolic murmur along the right sternal border. Bedside echocardiography documented a giant polypoid tumour filling the right ventricle (RV), protruding to the right atrium and occluding tricuspid valve in systole. No tricuspid regurgitation and valve stenosis was recorded (Fig. 1A). A second mass located in the left atrium was attached to the atrial septum. With the diagnosis of myxoma, the patient was referred for computed tomography (Fig. 1B) and subsequent surgery. The masses were excised together with tricuspid valve due to extensive, irreparable damage to the anterior leaflet, and mitral biological pericardial prosthesis was implanted. Due to atrioventricular II-block, the patient required permanent pacemaker implantation. The patient remained asymptomatic and was discharged on the eighth postoperative day. Three months later, elective echocardiography revealed hyperechogenic masses in RV (1.5 × 1 cm), raising suspicion of a substantial thrombus formation (Fig. 1C). Additionally, the concomitant, moderate and centrally-located regurgitation of the valve prosthesis was recorded. A repeated echocardiogram performed after three months of anticoagulative therapy documented enlargement of the tumour diameter to 2.0 × 3.5 cm and a significant progression of prosthesis regurgitation. Second surgical inspection revealed a giant multiple myxoma which was subsequently excised (Fig. 1D, E). Leaflets of the prosthesis were thicker, stiff and shortened (Fig. 1F). Due to rapid biological valve degeneration, mechanical prosthesis was implanted. The postoperative course was uneventful. In 12 months of follow-up, no recurrence of myxoma was recorded. Herein we present a unique case of unexpected rapid biological prosthesis deterioration coupled with a giant RV multiple myxoma, early after surgical tumour excision and valve implantation. This case elucidates the requirement for short-term follow-up in patients with a primary diagnosis of multiple myxoma.

A case report of mitral valve sub obstruction by left atrial giant myxoma with severe heart failure

A case report of mitral valve sub obstruction by left atrial giant myxoma with severe heart failure

Giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava

Cardiac myxomas are the most common type of benign cardiac tumors and most of them occur in the left atrium but the biatrial myxoma is uncommon. We present a rare case of giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava. A 58-year old woman presented with exertional dyspnea and intermittent chest discomfort. The non-pedunculated tumor involved most of the interatrial septum and extended from the orifice of the inferior vena cava to the displaced mitral annulus and the lower left pulmonary vein. The resected specimen weighed 76 gram and measured 80 × 40 × 30 mm. She did not complain of dyspnea or show any sign of recurrence by echocardiography during the 2-year follow-up period.