Intracardiac Obstruction Research Articles

Report of a giant invasive, wall-penetrating cardiac lipoma

BackgroundCardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor’s extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients’ long-term prognoses.Case presentationA 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a “dumbbell-shaped” configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications.ConclusionIn this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.

Historical Left Atrial Myxoma Causing an Obstructive Shock

Learning Objectives: - Explore the clinical presentation and diagnosis of cardiac myxoma. -Find out the potential complications of cardiac myxoma, such as embolic events and heart failure. -Understanding the role of echocardiography in the diagnosis and management of cardiac myxoma. Background: Cardiac myxoma, an uncommon tumor forming in the heart, tends to occur in the left atrium and is generally non-cancerous in nature. The composition, size, and position of the tumor can lead to a range of varied signs and symptoms. These symptoms can range from barely noticeable to severe and may include heart ailments, pulmonary hypertension, and even strokes. The usual course of treatment involves surgical removal of the tumor to resolve the issue. Case Presentation: This manuscript presents a case report of a 33-year-old male patient who presented with sudden dyspnea and was diagnosed with an extraordinarily large left atrial myxoma causing cardiogenic shock. Despite plans for surgery, the patient's condition rapidly deteriorated and he eventually died due to persistent intracardiac obstruction. The article discusses the rarity of primary tumors in the heart, with myxoma being the most prevalent, and the non-specific symptoms that can manifest in a variety of ways, including cardiac, embolic, and systemic symptoms. The importance of echocardiography in diagnosing cardiac tumors and the potential complications of atrial myxomas, including mitral valve obstruction, congestive heart failure, and sudden death, are also discussed. Conclusion: The presence of a giant left atrial myxoma, although benign, can cause severe symptoms and even be life-threatening. Diagnosis is made through echocardiography, and surgical removal of the tumor is the recommended treatment, which should be performed promptly upon diagnosis.

A Rare Case Series: Cardiac Myxoma and their Versatile Presentation

Background: Although rare, cardiac myxomas are the most common primary cardiac tumor with an incidence of 0.5 per million per year. Clinical presentation is variable and ranges from intracardiac obstruction, embolization to the pulmonary and systemic circulation, heart failure or constitutional symptoms. Surgical resection is the only effective treatment to prevent its debilitating and catastrophic complication. Case summary: Here, three atypical presentations as well as three different locations of cardiac myxomas were reported. First one is a rare case of ST-elevated myocardial infarction due to myxoma that originated from the left ventricle. One case involved right sided myxomas with pulmonary embolism. The third case involved huge left atrial myxoma combined with recurrent syncope. All three cases were almost misdiagnosed due to their atypical presentation. Echocardiography was the primary tool for detecting and diagnosing these cases. Subsequently all three patients underwent successful resection of myxoma. We also review clinical presentations and diagnostic characteristics of cardiac myxomas. Conclusion: Rare cardiac myxomas may have various clinical and imaging features. Physicians especially other non-cardiologist must increase their awareness of this disease and engage in the early diagnosis. Echocardiography is the diagnostic procedure of choice. The long-term survival after surgical resection is excellent and recurrence is rare. Bangladesh Heart Journal 2024; 39(1): 63-68

Anesthetic management of a patient posted for ruptured aneurysm repair with asymptomatic atrial myxoma

Abstract Atrial myxomas are rare cardiac tumors. It has to be surgically resected early when diagnosed, due to possible complications such as intracardiac obstruction, embolus, and metastasis. It becomes more challenging when found as an incidental finding in routine evaluation for a case of a ruptured aneurysm. Atrial myxoma is a common cause of ischemic and hemorrhagic strokes, but in 10%–15% of cases, it is associated with the development of metastatic intracranial aneurysms which is a rare complication of myxomatous emboli. We report the case of a 42-year-old female patient presented with subarachnoid hemorrhage, posted for the repair of left paraclinoid internal carotid artery aneurysm under general anesthesia with left interatrial septum myxoma.

Excision of Atrial Myxoma Through a Totally Thoracoscopic Approach on the Fibrillating Heart.

Cardiac myxomas are the most common form of primary cardiac neoplasms. Although benign, they can be deleterious by causing embolic events and intracardiac obstruction. After complete surgical resection, the prognosis is excellent. Although isolated case reports performing video-assisted thoracotomy on the arrested heart have been published, median sternotomy with central cannulation remains the standard approach. We herein describe the case of a morbidly obese patient undergoing successful total resection of a left atrial myxoma using a completely thoracoscopic approach on the fibrillating heart.

Operative management and outcomes in patients with myxomas: A single-center experience.

Cardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma. This study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection. The mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%. Recurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality.

P324 A CASE OF ATRIAL MYXOMA WITH UNUSUAL CLINICAL PRESENTATION

Myxoma (mx) is the most frequent adult cardiac tumour, that often poses a difficult diagnostic challenge due to the variety and aspecifity of presenting clinical signs. Alongside the more typical clinical onset caused by intracardiac obstruction and systemic embolization, mainly at cerebral level, a mx may initially manifest itself with nonspecific systemic symptoms such as fever, weight loss, fatigue, skin rash, myalgia and arthralgia. We present the case of a 58–year–old woman diagnosed in December 2018 with idiopathic, serum–negative arthritis of the metacarpophalangeal joint of the first finger of the right hand, treated with methotrexate (Reumaflex 10 mg/week s.c.), hydroxychloroquine sulphate (Paquenil 200 mg/day per os) and corticosteroids cycles; in January 2021, this therapy was suspended by the patient (pt) as ineffective. In April 2021, pt was admitted for bilateral SARS–CoV–2 pneumonia. As dyspnoea and fatigue persisted during moderate physical activity (NYHA class II), the pt underwent a cardiological examination on 13 August, when echocardiographic diagnosis of a left atrial mass with the appearance of a mx was made. Interleukin–6 (IL–6) was assayed for a suspected relationship between the cardiac tumour and rheumatic symptoms and was found to be elevated (490 pg/m)l. On 23 August, cardiac surgery was performed to remove the left atrial mass by right minithoracotomy. Histopathological examination confirmed that the 3.5 x 2.5 x 1.5 cm neoformation was a mx. On 1 September, strong attenuation of joint pain and IL–6 reduction to 107 pg/ml was detected. On 9 October, resolution of rheumatic symptoms and normalisation of IL–6 to 3.7 pg/ml (N.V < 7) occurred. This clinical case is emblematic of the long time that sometimes can elapse between the first clinical manifestation and the diagnosis of mx. Also the widespread use of echocardiography did not significantly reduce the diagnostic delay when cardiac symptoms are absent. In a large number of cases, onset symptoms mimicking autoimmune connective tissue disease are reported for 5% (“Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases” Medicine (Baltimore) 2001 May;80(3):159–729). The monoarticular localisation we describe is however unusual. Finally, our observation confirms that the association between mx and systemic symptoms is most likely due to IL–6 synthesis by tumour cells.

P116 GIANT LEFT ATRIAL MYXOMA CAUSING ACUTE ISCHEMIC STROKE

Abstract Aims Primary cardiac tumours are rare; most are benign, and around half are myxomas, often located in the left atrium. Clinical presentation is variable. Ischaemic stroke is a rare, although real and potentially fatal, complications of cardiac myxomas. Case Report We present a case of a 51–year–old man, ex– smoker, obese, with history of hypertension and COPD, presented to our emergency department with right–sided hemiplegia and aphasia caused by ischaemic stroke. Brain CT revealed cerebral perfusion deficit. The patient was underwent intravenous thrombolytic strategy. TTE showed a large left atrial mass attached to the interatrial septum, with a friable appearance, suggestive of myxoma. The 2D and 3D TEE detected a giant space–occupying mass in the left atrium, coral–like, and the most apical portion prolapsed into the left ventricle during diastole, causing fixed obstruction to flow in the left ventricular inflow tract. In view of the risk of imminent embolization, the emergent surgical excision of the tumour was performed. Subsequent histopathological findings confirmed the diagnosis of myxoma. Symptomatic cardiac myxoma may present with one of the three classic clinical presentations of the Goodwin’s triad, which include intracardiac obstruction, constitutional symptoms, and embolism. The obstructive pattern mimics atrioventricular valve obstruction. Constitutional manifestations include fatigue, fever, weight loss. Systemic embolization from myxoma occurs in around a third of cases. Of these, the most serious is cerebrovascular embolism, which may result in cerebral stroke. The tumour size, location, and macroscopic appearance, along with mean platelet volume and platelet count, are closely associated with embolic events. Echocardiography remains the method of choice for diagnosis and morphological characterization of myxoma. Two patterns have been established by echocardiography: round, with a solid appearance and a firm surface, and polypoid, with an irregular outline and a friable surface. The incidence of systemic embolization is higher in those with an irregular and friable surface and those that prolapse into the ventricle. Once a diagnosis of myxoma is established, surgical resection is the only effective treatment and should be performed immediately, in view of the risk of embolization. Conclusions With this case report, we stress the importance of echocardiography in new onset of neurological deficit to prevent potentially fatal outcomes.

Cardiac myxomas: A narrative review

Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.

Atypical Symptom and Clinical Features of Right Atrial Myxoma: A Case Report

Cardiac tumors are rare in medicine. Myxomas are the most common benign cardiac tumors. Most myxomas (>80%) are found in the left atrium. The site of 15-20% of cases of myxoma is the right atrium. The incidence of cardiac myxoma peaks at 40 to 60 years of age. Most atrial myxomas occur sporadically and are more common in middle-aged women. Patients with atrial myxoma usually have one of the symptoms in the following tetrad: embolic phenomena, intracardiac flow obstruction, arrhythmias and constitutional symptoms. The modality of choice for diagnosis of cardiac myxoma is an Echocardiography. Surgery should be considered promptly, because embolic complications or sudden death can be occured. This surgery is usually safe with low morbidity and mortality. Operative mortality is reported to be within 5%, and will be increased with myxoma occurring in the ventricle. Our case was a 47-year-old Iranian male with right atrial myxoma and a history of heart burn, he does not mention fever and chill, cough, chest pain or dyspnea. In CT Angiography of pulmonary artery showing pulmonary thromboembolism. After echocardiography and pulmonary CT angiography he underwent cardiac surgery and mass with adhesion to the right atrial wall near the IVC was excised. The patient was discharged after surgery with good general condition and stable vital signs.

574 Giant left atrial myxoma in ischaemic stroke

Abstract Aims Primary cardiac tumours are rare; most are benign, and of these, around half are myxomas, often located in the left atrium. Clinical presentation is variable. Ischaemic stroke is a rare, although real and potentially fatal, complications of cardiac myxomas. Methods and results We present a case of a 51-year-old man, ex- smoker, obese, with a history of hypertension and COPD, presented to our emergency department with right-sided hemiplegia and aphasia caused by ischaemic stroke. Brain computed tomography revealed cerebral perfusion deficit. The patient was underwent intravenous thrombolytic strategy and intubated transferred in Reanimation. TTE showed a large left atrial mass attached to the interatrial septum, with a friable appearance, suggestive of myxoma. The 2D and 3D TEE detected a giant space-occupying mass (60 × 20 mm diameter) in the left atrium, coral-like, and with a friable appearance, the most apical portion prolapsed into the left ventricle during diastole, causing fixed obstruction to flow in the left ventricular inflow tract. Computed tomography angiography (CTA) confirmed the giant mass in the left atrium. In view of the risk of imminent embolization, the emergent surgical excision of the tumour was performed. The tumour and its neck, including part of the atrial septum, were fully resected and the atrial septum was directly closed. Subsequent histopathological findings confirmed the diagnosis of atrial myxoma. Post-operative echocardiography showed no residual tumour. Symptomatic cardiac myxoma may present with one of the three classic clinical presentations of the Goodwin’s triad, which include intracardiac obstruction, constitutional symptoms, and embolism. The obstructive pattern mimics mitral or tricuspid valve disease and results from atrioventricular valve obstruction. Constitutional or systemic manifestations include fatigue, fever, weight loss, arthralgia, myalgia, erythematous rash, and laboratory findings such as anaemia and elevated ESR, CRP, and globulins. Systemic embolization from myxoma occurs in around a third of cases. Of these, the most serious is cerebrovascular embolism, which may result in cerebral stroke. In addition, embolization of coronary arteries, kidneys, intestines, and extremities can also occur. The tumour size, location, and macroscopic appearance, along with mean platelet volume and platelet count, are closely associated with embolic events. Echocardiography remains the method of choice for diagnosis and morphological characterization of myxoma. Two patterns have been established by echocardiography: round, with a solid appearance and a firm surface, and polypoid, with an irregular outline and a friable surface. The incidence of systemic embolization is higher in those with an irregular and friable surface, as well as in polypoid tumours and those that prolapse into the ventricle. Once a diagnosis of myxoma is established, surgical resection is the only effective treatment and should be performed immediately, in view of the risk of embolic complications. Conclusions With this case report, we stress the fundamental importance of echocardiography in new onset of neurological deficit to prevent potentially fatal outcomes.

A case report of left atrial myxoma presenting with amnesia

BackgroundPrimary cardiac tumors are rare, and approximately 90% of them are benign. Myxoma is the most common type of these tumors occurring in the left atrium in 75–85% of cases. The tumor can cause the left atrio-ventricular valve obstruction and embolization phenomenon.Case presentationWe reported a case of 54-year-old man with complaints of dyspenea and amnesia. In our patient, transthoracic echocardiography revealed a mass of 28*63 mm attached to the upper intra-atrial septum, which was prolapsing through the mitral valve into the left ventricle during diastole, being indicative of the left atrial myxoma. On examination, he was alert and conversant, and no pathological abnormality was observed in the examination of cardiovascular, gastrointestinal, respiratory, hepatic, renal and nervous systems. After myxoma diagnosis, the tumor was removed under cardiac surgery and discharged under good conditions. In the telephone follow-up after discharge, the patient recovered and did not report the disease and surgery complications.ConclusionsPatients with cardiac myxoma are usually asymptomatic, but they may have manifestations related to the embolism phenomenon or intracardiac obstruction. Therefore, myxoma may represent an emergency. Surgery should be performed as soon as possible. If surgery is delayed, the patient may suffer from serious and irreversible complications, such as stroke and cardiac arrest.

Early Outcomes for In Situ Pericardial Roll Repair for Distant Anomalous Pulmonary Venous Return

Repair of anomalous pulmonary venous return (APVR) when veins are remote from the left atrium (LA) is challenging and may eventuate in a higher prevalence of pulmonary vein stenosis, superior vena cava stenosis, or intracardiac baffle obstruction. We describe our experience in 6 patients with a technique, using both anterior and posterior in situ pericardial roll repairs, which reduces these complications. Six patients underwent in situ pericardial roll repair of APVR at Cleveland Clinic between 2018 and 2019. Median age was 40 years (range, 0.25-65 years). Three patients had partial APVR of right upper and middle veins into superior vena cava high above the right pulmonary artery without atrial septal defect; 2 had scimitar syndrome, and the infant had heterotaxy with unbalanced atrioventricular canal and mixed obstructed total APVR. The anomalous pulmonary vein drained into the respective cava far from the LA, which was not ideal for traditional repair techniques. In situ pericardial roll directed anomalous pulmonary vein to the LA. Most patients had concomitant complex cardiac procedures. There was no mortality. Median hospital stay was 23 days (range, 4-60 days) and median follow-up was 20 months (range, 1-36 months). The infant required percutaneous dilatation and stenting of LA anastomosis but since underwent ventricular switch. At last follow-up, pulmonary veins were unobstructed and adult patients were asymptomatic with excellent functional status. In situ autologous pericardial roll is a useful technique that abrogates the need for mobilization of distant anomalous pulmonary vein with direct anastomosis or complex intracardiac baffles. It is suitable for multiple anatomic configurations and can be used in infants and adults.

The omitted symptoms challenge the diagnosis of right atrial myxoma: a case report

BackgroundCardiac myxoma (CM) is the most common type of primary cardiac tumors. The prevalence of primary cardiac tumors is 0.0017–0.28% in various autopsy studies. The clinical symptoms of CM which includes embolism, intracardiac obstruction, general or constitutional manifestations and infected myxoma are largely depended on the size, growing speed, location and pedicle length of the tumor. The following case reported a missed diagnostic case of a right atrial myxoma firstly presented digestive, systemic symptoms and immunologic disorder, leading to emergent tricuspid valves obstruction situation.Case presentationWe reported a critical case of a 51-year-old female with CM was firstly admitted to the gastroenterology clinical department because of poor appetite, marked fatigability and weight loss for 2 months. The physician diagnosed her as chronic gastritis and treated her with some symptomatic treatment such as ilaprazole and magnesium aluminum carbonate. After months without definitive diagnosis, this right atrial myxoma grew into right ventricle and obstructed the tricuspid valves, causing her dyspnea, sweating, dizziness, feeling of impending death when she was sleeping. Transthoracic echocardiogram revealed a 6.1 × 4.2 × 3.7 cm2 mass adjacent to tricuspid valves. The patient underwent surgical excision and pathology revealed a primary cardiac myxoma.ConclusionThis case reported a critical result of missed diagnosis of right atrial myxoma and showed its systematic symptoms and immunologic disorder, highlighting the importance of systematic examinations on patients. Furthermore, it appeals early diagnosis of CM and consideration of drug targets to suppress CM development.

Atrial myxoma with cerebellar signs: a case report

BackgroundAtrial myxoma remains a rare clinical entity with an incidence of surgically resected cases of 0.5–0.7 per million population and prevalence of < 5 per 10,000. It typically manifests in woman after third decade of life; symptoms vary greatly and may present with arrhythmia, intracardiac flow obstruction, embolic phenomenon, and associated constitutional symptoms. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Cerebellar involvement is very rare and only a few cases have been reported in the literature.Case presentationA 55-year-old Brahmin man with no history of diabetes mellitus and hypertension, presented with complaints of dizziness, headache, vomiting, double vision, and unsteadiness of gait for 2 weeks. His headache was sudden in onset, of a pulsating type and localized on left temporal side. Vomiting was projectile and bilious. Double vision was present in all directions of gaze and he had uncoordinated movement of his body and tilting to the left side. On examination, his cerebellar functions were impaired. He was thoroughly investigated for the cause of stroke after abnormal magnetic resonance imaging results with normal computed tomography angiography of his brain. Echocardiography and computed tomography of his chest showed a mass attached to intra-atrial septum and prolapsing through mitral valve, which was suggestive of left atrial myxoma. Five days following admission, he developed abdominal pain due to thromboembolism causing splenic and renal infarct.ConclusionAlthough rare, atrial myxoma has to be considered a cause of stroke and other embolic phenomenon causing multiorgan infarctions. Early and timely diagnosis of the condition can prevent further recurrence and inappropriate anticoagulant therapy. It would be pertinent to have echocardiography done in patients who present with a stroke, arrhythmias, and other constitutional symptoms. The tumor once detected must be removed surgically as early as possible, which not only reduces serious thromboembolic complications but can be potentially curative.

Intraoperative Cardiogenic Shock Caused by Intracardiac Tumor Thrombi Obstruction

A 60-year-old man presented with left flank pain, a palpable abdominal mass, and hematuria for months. Computed tomography revealed a large tumor in the left kidney (approximately 17.7 cm in diameter) with evidence of left adrenal, left renal vein, and inferior vena cava (IVC) invasion. He underwent left nephrectomy with IVC thrombectomy. Transesophageal echocardiography (TEE) was used during the whole procedure and the tumor was found in the IVC (Fig-1) before resection.

P1460 Atrial myxoma with atypical location in an asymptomatic patient

Abstract Introduction Primary cardiac tumours are rare. Most of them are benign, among which myxomas are the most common. Usually they occur in the left atrium (75%) but there are cases of right atrial myxomas. The majority of patients with atrial myxoma present with one or more symptoms of clinical triad of embolic events, intracardiac obstruction, or nonspecific manifestations. We report a rare case of cardiac myxoma arising from the right atrium as an accidental finding during routine medical checkup. Case report A 52 years-old woman was admitted to ambulatory care for a general checkup. At presentation, her heart rate was 82 bpm, regular and blood pressure was 150/90 mmHg. Other investigative results were normal. Her ECG showed normal sinus rhythm. She was sent for a routine echocardiography to judge for further treatment of the arterial hypertension. Transthoracic echocardiogram showed normal left ventricular ejection fraction. There was a mobile echogenic mass of nearly 6 cm2 in the right atrium, prolapsing through the tricuspid valve with mild tricuspid regurgitation without causing obstruction and protruding into the inferior vena cava (IVC). The transesophageal echocardiographic examination confirmed the presence of a mobile multilobular mass in the right atrial free wall close to the IVC origin. A total body angio-CT scan showed an intraatrial mass measuring approximately 5 × 4 cm, without infiltration of the adjacent structures, suggesting the diagnosis of myxoma. Coronary angiography revealed normal coronary arteries. The patient underwent median sternotomy under general anesthesia. The tumor was completely excised through a right atriotomy. The resected mass was sent for histological assessment which confirmed the diagnosis of myxoma. Discussion RA myxomas usually originate in the fossa ovalis or base of the interatrial septum, but in this case, the myxoma was implanted in the atrial inferior vena cava junction. Myxomas are usually polypoid and pedunculated tumors (approximately 83% of cases). In this report, our patient had a solitary, pedunculated mass with polypoid areas and a lobulated surface. Echocardiography remains the best diagnostic method for locating and assessing the extent of myxomas and for detecting their recurrence, with a sensitivity of up to 100%. However, transthoracic echocardiogram may not identify tumors smaller than 5 mm in diameter, and a transesophageal echocardiogram is required when there is suspicion of a very small tumor. In this case, an echocardiogram suggested the hypothesis of RA myxoma, which was confirmed by a histopathological exam. Myxomas are friable with high chance of systemic or pulmonary embolization depending on tumour location. Early diagnosis and timely surgical resection is the treatment of choice to prevent possible fatal consequences such as sudden death. Abstract P1460 Figure. Right Atrial Myxoma

P1697 A rare case: primary cardiac sarcoma in the left and right atrium presenting with dispnea due to mitral valvular obstruction

Abstract Introduction Primary cardiac tumors are extremely rare; the incidence is approximately 0.001% to 0.03%. Malignant tumors account for 25% of primary cardiac tumors, and among those, sarcomas are the most prevalent. We report a case of primary cardiac sarcoma presenting with dyspnea due to mitral valvuler obstruction. Case Report A 41-year-old woman was admitted to the hospital with dyspnea for 8 months without any obvious causes. She was healthy previous and without family history. Physical examination was normal. Thorax computed tomography (CT) scan was performed with the doubt of pulmonary disease. A 1x1 cm hypodense nodule was detected in superior segment of the right lower lobe lung. Positron emission tomography-computed tomography (PET-CT) revealed a 1*1 cm nodule in the lung. And also increased 18F-fluorodeoxyglucose uptake was observed in the left scapula, left iliac wing and right 4th rib, likely due to metastasis. Biopsy from the lesion of iliac wing was performed. Pathologic examination was primarily compatible with the malign mesenchymal tumor and sarcoma infiltration; but malignant epithelial tumor and metastasis of carcinoma could not be ruled out. Magnetic resonance imaging of the lung was performed to find the origin of the metastatic tumor. A 8,6 x 5,3 x 5,1 cm mass filling the right and left atria was detected.It was extending from the right atrium to the superior vena cava and also from the left atrium to the right inferior and superior pulmonary venules. The image of mass was compatible with sarcoma. Transthoracic echocardiography was performed. A mass in the left and right atrium was detected. It was filling the left atrium. Due to the mass, the maximum mitral gradient was 21 mm Hg and the mean mitral gradient was 10 mm Hg, as if there was mitral stenosis.Systolic pulmonary artery pressure was 40 mmHg. Mild mitral insufficiency was detected. The patient was evaluated with the department of oncology and cardiovascular surgery. It was decided that the mass was inoperable. So transesophageal echocardiography was not performed. It was thought that, the mass was primary cardiac sarcoma, pulmonary nodule and bone lesions were metastasis of this primary cardiac sarcoma. So chemotherapy protocol (ifosfamide,adriamycin,mesna) was started. Conclusion Cardiac tumors have many clinical presentations. Early stages of the disease are often asymptomatic. In advanced stages, patients present with symptoms of the classic triad (intracardiac obstruction, systemic embolization, constitutional symptoms) Symptoms are often non-spesific; so diagnostic suspicion is very important. Although cardiac sarcoma therapy includes complete surgical excision, followed by radiotherapy and chemotherapy, prognosis is still poor. Surgery can offer dramatic palliation of symptoms in cases of valvular obstruction. In conclusion, it remains clear that early diagnosis and treatment are extremely important because of their prognostic and therapeutic value. Abstract P1697 Figure.

THE ASSOCIATION BETWEEN INTRACARDIAC HEMODYNAMICS AND LUNG FUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Study objective. To assess the association between intracardiac hemodynamics and airway obstruction with pulmonary hyperinflation in patients with chronic obstructive pulmonary disease.Materials and methods. Ninety-six patients with chronic obstructive pulmonary disease, aged 40 to 75 years, without concomitant cardiovascular disease, were examined and divided into 4 groups according to the severity of the disease. The patients underwent general clinical examination, spirometry, 24-hour pulse oximetry and echocardiography with assessment of linear and volumetric parameters, as well as diastolic function of left and right ventricles.Results. Linear and volumetric parameters of the left ventricle, LV myocardial mass and geometry in the examined patients with chronic obstructive pulmonary disease matched threshold values. The progression of the severity of chronic obstructive pulmonary disease was accompanied by decrease of the end-diastolic size of the left ventricle, ratio of peak early to late diastolic filling velocity for the left ventricle (E/A) without significant changes in the left ventricle isovolumetric relaxation time (IVRT). Moderate correlations of the inspiratory capacity with the end-diastolic size of the left ventricle (r=0.612; p=0.001) and the left ventricle E/A (r=0.464; p=0.001); forced expiratory volume in 1 second (FEV1) with the left ventricle E/A (r=0.600; p=0.011) were established. As a result of the logistic regression performed, the predictor value of the inspiratory capacity was confirmed (Wald χ2 — 5.795; р=0.024). Impairment of left ventricular diastolic function of grade I was revealed in 12 (31.6 %) patients in group 2, in 7 (24.1 %) patients in group 3, and in 9 (56.2 %) patients in group 4.Conclusion. Airway obstruction severity and pulmonary hyperinflation progression in patients with chronic obstructive pulmonary disease and without concomitant cardiovascular disease is associated with a decrease of left ventricular size and diastolic filling, contributes to the development of the left ventricular diastolic dysfunction, predominantly due to the decrease in filling velocity parameters.

BREATHTAKING DIAGNOSIS: ATRIAL MYXOMA

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Primary cardiac tumors are one of the least investigated subjects in oncological medicine. Among these primary cardiac tumors, atrial myxoma is one of the most common primary cardiac tumors mostly arising in the left atrium.We present a unique case of atrial myxoma that will highlight the broad importance of differential diagnosis in inpatient and outpatient setting. CASE PRESENTATION: A 57-year-old female presented for outpatient CT scan of the chest to rule out pulmonary embolism due to continued dyspnea at rest and orthopnea following upper respiratory tract infection. A CT scan of the chest was negative for pulmonary embolism; however, it revealed a 4.9 x 4.8 cm low-density mass in the left atrium (Panel A, arrow). A transesophageal echocardiogram showed a large heterogeneous left atrial mass attached to the interatrial septum with characteristic "plop” across the mitral valve causing functional mitral stenosis (Panel B, arrow). Cardiac catheterization revealed non-obstructive left anterior descending and right coronary arteries; however, left circumflex coronary artery was not visualized despite aortic root angiography indicating congenital absence (Panel C, arrows [LAD and RCA denote left anterior descending and right coronary arteries, respectively]). The patient underwent surgical resection of the mass (Panel D). Biopsy of the mass revealed tumor cells with elongated and fusiform stellate with bland nuclei and eosinophilic cytoplasm with dense lymphocytic aggregation consistent with myxoma (Panel E and F). The postoperative course was unremarkable. DISCUSSION: Myxomas are the most common benign primary cardiac tumors and occur predominantly in the left atrium and in women. Patients typically present with symptoms of heart failure secondary to mitral inflow obstruction; however, one-third of the patients, especially men present with the embolic phenomenon. Cardiac myxoma disproportionately affects the female population with 65% of myxomas occurring in them. Secondary of myxomas being familial in 4.5 to 10% of the cases it is recommended to screen first degree relatives [2]. Multiple theories have been proposed regards to the origin of these tumors. The initial thought process was to classify them as organized thrombotic structure but histological and molecular investigations reported the expression of different cardiac myocytes and transcription factors lead to propose that these lesions might have mesenchymal cardiomyocyte progenitor cells [3]. Cardiac myxomas even though classified as benign tumors have a tendency to seed in other locations causing inflammation, embolism, or intra-cardiac obstruction leading to mortality and significant morbidity. CONCLUSIONS: Prompt diagnosis is crucial since the results of surgical resection are excellent with dramatic symptoms improvement and rapid postoperative recovery. Reference #1: Lam, K. Y., Dickens, P., & Chan, A. C. (1993). Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Archives of pathology & laboratory medicine, 117(10), 1027-1031 Reference #2: Ekmektzoglou, K. A., Samelis, G. F., & Xanthos, T. (2008). Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. Journal of Cardiovascular Medicine, 9(8), 769-777. Reference #3: Amano J, Kono T, Wada Y, Zhang T, Koide N, Fujimori M, Ito K. Cardiac myxoma: its origin and tumor characteristics. Ann Thorac Cardiovasc Surg. 2003;9(4):215–221 DISCLOSURES: No relevant relationships by Pranjal Boruah, source=Web Response No relevant relationships by Gaurav Patel, source=Web Response No relevant relationships by Muhammad Siddique Pir, source=Web Response No relevant relationships by najam saqib, source=Web Response