Left Atrial Mass Research Articles

Association of type 2 diabetes mellitus and ratio of transmitral E wave velocity to early diastole mitral velocity with cardiovascular events in chronic kidney disease.

The association between DM and left ventricular diastolic dysfunction, assessed using the ratio of peak early transmitral filling wave velocity (E) to early diastolic velocity of mitral annulus (Ea), with cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) remains uncertain. This study included 356 CKD stage 3–5 patients underwent echocardiography. All patients were classified into four groups based on the presence of DM and E/Ea ≤ or > 9. CV events included CV death, hospitalization for heart failure, unstable angina or nonfatal myocardial infarction, sustained ventricular arrhythmia, transient ischemic attack, and stroke. There were 58 CV events during the mean observation period of 25.0 months. A combination of the presence of DM and E/Ea > 9 (vs. a combination of non-DM and E/Ea ≤ 9) was associated with CV events in unadjusted model (hazard ratio [HR], 6.990; 95% confidence interval [CI], 2.753–17.744; p < 0.001), and in a multivariate adjusted model (HR, 3.037; 95% CI, 2.088–7.177; p = 0.025). In the patients without DM, the E/Ea ratio (p = 0.033) improved the prediction of CV events, compared to the E/Ea ratio (p = 0.018), left atrial diameter (p = 0.016) and left ventricular mass index (p = 0.001) in the patients with DM. The combination of DM and left ventricular diastolic dysfunction was associated with CV events in patients with CKD stage 3–5. Assessments of DM status and E/Ea ratio may facilitate identifying high-risk patient population of unfavorable CV outcomes.

Impact of Weight Loss in Improvement of Heart Geometry after Bariatric Surgery

Obesity is commonly associated with an increase in sympathetic activity and higher mortality. Obesity and bariatric surgery also have a direct impact in the heart geometrical modification. The aim of this study was to analyze the extent of changes in the heart ventricular function and structure after weight loss after bariatric surgery. We retrospectively reviewed all the patients who underwent bariatric surgery between 2010 and 2015. The data included patient demographics, BMI, and comorbidities. The pre- and postoperative echography readings were compared. Fifty-one patients who had bariatric procedures and had echocardiography before and after the surgery were identified. There were 31 females (60%). The mean age was 61.8±11 years with an average BMI of 40.7±7.89. The mean follow-up was 1.2 years after the procedure. At 1 year follow-up, 25 patients (49%, p=0.01, 95% CI) showed normal left ventricular geometry. The left atrial mass (229±82.1 vs 193.2±42.5, p<0.01, 95% CI) and the left ventricular end diastolic volume (129.4±53 vs 96.4±36.5, p=0.01, 95% CI) showed a significant modification after the procedure. There was significant modification in the interventricular septal thickness (p=0.01, 95% CI) and relative wall thickness (p<0.01, 95% CI) after surgery. Most of the obese patients present a significant cardiac remodeling from concentric remodeling to normal geometry after bariatric surgery. The decrease in BMI has a direct effect in the improvement of the left ventricular structure. Further studies have to be carried out to define the impact of obesity to the diastolic function.

Post Rheumatic Tricuspid Valve Disease Associated to a Left Atrial Mass in a Young Female: a Case Report

Primary lesions of the tricuspid valve are rare Tricuspid disease is an uncommon valvular abnormality that most commonly occurs in association with other valvular lesions particularly in patients with rheumatic heart disease For many years surgical commissurotomy and valvuloplasty were the only available methods to correct tricuspid disease We present a case of post rheumatic disease of the tricuspid valve in a young girl associated to a left atrial mass nbsp

Insulin resistance, serum uric acid and metabolic syndrome are linked to cardiovascular dysfunction in pediatric obesity.

Childhood obesity is associated with cardiovascular abnormalities but little is known on the potential correlation between early cardiovascular and metabolic alterations. Aims of this study were 1) to evaluate early cardiovascular abnormalities in a large population of obese children and adolescents compared with a normal weight counterpart, 2) to investigate their potential association with insulin resistance (IR), serum uric acid (sUA) and metabolic syndrome (MetS). This was a single-center case-control study. Eighty obese (OB) subjects (6-16years) and 20 normal weight (NW) matched controls were consecutively recruited. In the whole population we performed an anthropometric and a cardiovascular assessment. OB patients also underwent an OGTT and biochemical evaluations. OB children showed greater left atrial (LA) and ventricular (LV) dimensions and mass and higher carotid artery intima-media thickness (CIMT), compared with NW controls. The BMI z-score, waist circumference, IR and sUA were positively related with LA and LV dimensions and mass. OB subjects with MetS (46.3%) showed greater LA diameter (p=0.001) and LV area (p=0.01) and volume (p=0.04) compared with OB children without MetS. LA diameter and LV dimensions and mass were significantly dependent on the number of criteria for MetS. Mets, sUA and IR were significant predictors of left heart dimensions and mass in obese children. Obesity and MetS are associated with abnormal cardiovascular response during childhood. Hyperuricemia can be an early marker of cardiovascular dysfunction and the routine determination of circulating levels of sUA should be implemented during risk stratification among pediatric age.

Cardiac myxoma with glandular elements: A case report

Cardiac myxoma with glandular elements is extremely rare cardiac myxomas that show glandular differentiation, the pathogenesis of which is unknown. The present case study reports a case of glandular cardiac myxoma. A 21-years-old female presented with left atrial mass which was surgically resected and sent for histopathological examination. Microscopically, there were well formed mucinous glands in a background of cardiac myxoma and hence cardiac myxoma with glandular elements was confirmed. Though rare, it should always be differentiated from metastatic adenocarcinoma.

P4927Serum proatrial and B-type natriuretic peptide do not increase with higher systolic blood pressure in obese men despite evidence of greater left atrial size and higher left ventricular mass

P4927Serum proatrial and B-type natriuretic peptide do not increase with higher systolic blood pressure in obese men despite evidence of greater left atrial size and higher left ventricular mass

Left atrial remodeling, hypertrophy, and fibrosis in mouse models of heart failure.

Left ventricular dysfunction increases left atrial pressures and causes atrial remodeling. In human subjects, increased left atrial size is a powerful predictor of mortality and adverse events in a broad range of cardiac pathologic conditions. Moreover, structural remodeling of the atrium plays an important role in the pathogenesis of atrial tachyarrhythmias. Despite the potential value of the atrium in assessment of functional endpoints in myocardial disease, atrial pathologic alterations in mouse models of left ventricular disease have not been systematically investigated. Our study describes the geometric, morphologic, and structural changes in experimental mouse models of cardiac pressure overload (induced through transverse aortic constriction), myocardial infarction, and diabetes. Morphometric and histological analysis showed that pressure overload was associated with left atrial dilation, increased left atrial mass, loss of myofibrillar content in a subset of atrial cardiomyocytes, atrial cardiomyocyte hypertrophy, and atrial fibrosis. In mice undergoing nonreperfused myocardial infarction protocols, marked left ventricular systolic dysfunction was associated with left atrial enlargement, atrial cardiomyocyte hypertrophy, and atrial fibrosis. Both infarcted animals and pressure overloaded mice exhibited attenuation and perturbed localization of atrial connexin-43 immunoreactivity, suggesting gap junctional remodeling. In the absence of injury, obese diabetic db/db mice had diastolic dysfunction associated with atrial dilation, atrial cardiomyocyte hypertrophy, and mild atrial fibrosis. Considering the challenges in assessment of clinically relevant functional endpoints in mouse models of heart disease, study of atrial geometry and morphology may serve as an important new tool for evaluation of ventricular function.

Left Atrial Myxoma: A Case Report and Review of Literature

Primary cardiac tumors are an infrequent cause of symptoms mimicking valvular heart disease, congestive heart failure, arrhythmias, conduction defects and pulmonary disease. The rarity of this condition can lead to significant delay and cause patient distress. Here, we present a case of an unusual prolapsing left atrial myxoma in a 61-year-old female who presented with several months of dyspnea. The patient endorsed weight loss and night sweats during this period and treatment with antibiotics and steroids for pulmonary symptoms had not provided relief. Seven months after her initial presentation, an echocardiogram was performed revealing a 2.85 x 5.44 cm left atrial mass on the interatrial septum. The mass was resected by cardiothoracic surgery with complete resolution of her symptoms.

The left atrial bacterial vegetative mass due to Corynebacterium striatum as a presentation of myxoma: a case report

BackgroundCorynebacterium striatum is a member of the non-diphtherial corynebacteria, which are ubiquitous in nature and generally colonize the skin and mucous membranes of humans. Rarely, it causes infective endocarditis (IE). We report a case of rare left atrial bacterial vegetative mass due to C. striatum masquerading as a myxoma identified through a tortuous diagnostic process, and present a brief review of the relevant literature.Case presentationWe present a case of 63-year-old man who presented with progressively worsening dyspnea on exertion and lower leg edema, and was diagnosed with heart failure. Transesophageal echocardiography (TEE) revealed that the left atrium was filled with a 2.7 cm × 2.6 cm mass. The patient, who had no signs of infection or related risk factors, was suspected of having a left atrial myxoma clinically. After excising the mass, the histopathology suggested thrombus with no myxocytes. Postoperatively, a fever appeared and C. striatum was isolated from the blood cultures. Although antibiotics were used, the symptoms of heart failure worsened gradually and echocardiography revealed valve vegetation. The patient underwent a second operation because of IE. Surprisingly, the mass was confirmed to be a bacterial vegetation due to C. striatum based on Gram staining at a 1000× magnification, although this was not noted on routine pathological examination of the two surgical specimens.ConclusionsPhysicians should be aware of Corynebacterium in blood cultures, which cannot simply be assumed to be a contaminant. A diagnosis of IE should be suspected, particularly in high-risk patients or those with an unexplained fever. Our patient had IE due to C. striatum with no risk factors. This case supports the diagnosis of IE using a combination of pathology and etiology.

Mobile Left Atrial Mass – Clot or Left Atrial Myxoma

Mobile masses within the left atrial cavity are commonly caused by organized thrombi or left atrial myxoma. The use of transesophageal echocardiography has provided means for differentiation between the two conditions. We report a case of a left atrial mass in a middle age male patient having past history of closed mitral commissuro to my presented with mitral stenosis and atrial fibrillation. On transthoracic echocardiography (TTE) a round mass appeared freely mobile in left atrium but did not prolapse between the mitral leaflets due to the tightly stenosed valve orifice. In the presence of mitral stenosis, atrial fibrillation and dilated left atrium, the appearance of the mass was like mobile thrombus but possibility of left atrial myxoma cannot be ignored. Consequently, the patient was referred for surgical treatment and the mass removed through left atriotomy. Microscopic examination revealed a highly organized thrombus. We conclude that TTE is still a reliable tool in the diagnosis of large mobile atrial thrombi; TEE may help for differentiate clot from atrial myxoma but histopathological examination is a gold standard. Key words: left atrium, mitral stenosis, mitral valve replacement, CMC-closed mitral, commissurotomy.

Association Between Posterior Left Atrial Adipose Tissue Mass and Atrial Fibrillation

Epicardial adipose tissue located close to the atrial wall can change the electric conduction of the left atrium, potentially leading to atrial fibrillation (AF). The aim of this study was to assess whether an increased atrial adipose tissue mass posterior to the left atrium is related to AF independent of demographical and cardiovascular risk factors. Two hundred patients with AF and 200 patients without AF who underwent computed tomographic angiography were included. The posterior left atrial adipose tissue mass was quantified on computed tomographic angiography images as tissue with Hounsfield Units between -195 and -45. The adipose tissue mass was significantly larger in patients with AF compared with patients with sinus rhythm: 10.6±5.5 versus 4.7±3.5 g, P<0.001. In a multiple variable model (including age, body mass index, sex, coronary artery calcium score, diabetes mellitus, hypertension, hypercholesterolemia, family history of coronary artery disease, and known coronary artery disease), each gram increase of posterior left atrial adipose tissue was associated with 1.32 odds ratio of having AF (95% confidence interval, 1.22-1.43; P<0.001). Furthermore, the addition of the adipose tissue mass to the multiple variable analysis significantly increased the discriminatory ability to predict AF: increase in the area under the receiver operating characteristic, 0.88 (95% confidence interval, 0.84-0.91) versus 0.81 (0.76-0.85), P<0.001. Posterior left atrial adipose tissue mass is significantly larger in patients with AF versus without AF. An increase in adipose tissue was independently associated with AF and provided incremental value over well-known predictors of AF. These findings add to the hypothesis that the posterior left atrial adipose tissue mass contributes to structural and electric remodeling leading to AF.

Concomitant Left Atrial Myxoma and Patent Foramen Ovale: Is It an Evolutional Synergy for a Cerebrovascular Event?

We report a case of a 48-year-old female who presented initially with an abrupt onset of left facial and hand numbness after her routine yoga with no associated syncope, palpitation, chest pain or dyspnea. She consulted her primary care physician and recommended hospital care for possible stroke. On the day of admission, she complained of left facial and hand hemiparesthesia. Cranial imaging and angiography were unremarkable but echocardiography and cardiac computed tomography revealed left atrial mass. She underwent resection of the left atrial mass with an incidental finding of patent foramen ovale intraoperatively. The left atrial mass was confirmed to be an atrial myxoma. Patient’s neurologic complaints resolved towards the end of her hospital course. She was discharged stable with no recurrence of neurologic symptoms on health maintenance evaluation.

Left Atrial Mass in a Patient with Rheumatic Mitral Stenosis and Atrial Fibrillation-Thrombus or Myxoma?

Left Atrial Mass in a Patient with Rheumatic Mitral Stenosis and Atrial Fibrillation-Thrombus or Myxoma?

Multiple left atrial masses in a patient with breast cancer

Multiple left atrial masses in a patient with breast cancer

Congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa masquerading as left atrial mass in fetal life

A 28-week-old fetus was detected to have a single left atrial mass in prenatal ultrasound. Postnatal echocardiography showed an aneurysm between the anterior mitral leaflet and aortic valve, to the left of atrioventricular junction and communicating with the left ventricle through a narrow mouth. It probably originated from the mitral-aortic intervalvular fibrous tissue and an inherent weakness at this site might be the cause. Reported cases of pseudoaneurysm of mitral-aortic intervalvular fibrosa and subvalvular ventricular aneurysms seen following infective endocarditis, surgery, or trauma seem to have a similar anatomical background. This case explains the possibility of congenital aneurysm in this location which needs to be considered a differential diagnosis in similar cases.

Fungal Infective Endocarditis mimicking Atrial Myxoma: Transesophageal Echocardiography Assessment

ABSTRACT Infective endocarditis (IE) accounts for 0.5 to 1 of every 1,000 hospital admissions. This case describes a left atrial mass of fungal etiology mimicking an atrial myxoma. At times, the diagnosis of mass in left atrium can be a challenge, which is discussed in this report. How to cite this article Makhija N, Irpachi K, Rajashekar P, Siddharth CB. Fungal Infective Endocarditis mimicking Atrial Myxoma: Transesophageal Echocardiography Assessment. J Perioper Echocardiogr 2017;5(2):82-85.

The Deceptive Myxoid Appearance of a Low-Grade Cardiac Sarcoma and Its Accompanying Diagnostic Challenges: A Case Report

: We present a 40-year-old man with a recurrent left atrial mass, previously diagnosed as cardiac myxoma elsewhere. His new admission was due to a regrowth of the mass. Progressive exertional dyspnea was his major complaint. A large lobulated tumor was seen in echocardiography in the posterior wall of left atrium involving the posterior leaflet of mitral valve, and resulting in severe stenosis and diastolic protrusion of the mass into the left ventricle. Surgery showed a non-homogenous myxomatous mass which infiltrated the posterior wall of the left atrium and parts of the inter-atrial septum. As a result, the surgeon excised parts of the septum and the posterior wall and did a reconstruction with pericardial patches. The pathologic examination revealed soft creamy-brown tumoral fragments, m: 10 × 4 cm altogether. Contrary to his previous diagnosis, we observed a malignant neoplasm with cells that had plump, round to oval nuclei, set in a myxoid and vascular background, but mitotic figures and necrosis were not conspicuous. Therefore, we made a diagnosis of recurrent myxoid round cell sarcoma and recommended immunohistochemical (IHC) studies. Multiple IHC and histopathological studies elsewhere favored a diagnosis of myxoma which was not compatible with our diagnosis. A second recurrent mass was soon found in the left atrium making further surgical attempts impossible. At last, a diagnosis of myxoid leiomyosarcoma confirmed our diagnosis, but the patient was not fortunate enough to survive and passed away before heart transplantation could be done as a remedy.

A rare association of left atrial myxoma with rheumatic mitral stenosis

Primary cardiac tumors are very rare. Atrial myxomas are the most common primary tumors and are commonly located in the left atrium. Myxomas can cause mitral valve inflow obstruction and can present with clinical signs and symptoms of mitral stenosis and the possibility of myxoma should be considered in differential diagnosis of mitral stenosis. Left atrial myxoma is rarely associated with rheumatic mitral stenosis. Transesophageal echocardiography plays a major role in the diagnosis of this tumor. We report a case of an extremely rare association between left atrial myxoma and rheumatic mitral stenosis. Because of its location and mobility, a thrombus in the left atrium may have a similar appearance to left atrial myxoma. However, a careful inspection of features of the left atrial mass may allow a diagnosis of left atrial myxoma. In our case, the site near the atrial septum, heterogeneous echogenicity, and detection of a stalk connecting the myxoma to the atrial septum were inspected. Such findings essentially exclude thrombus.

Pedunculated left atrial mass

Pedunculated left atrial mass

Relation of Functional Status to Risk of Development of Atrial Fibrillation

Identifying patients at risk is now important as there are demonstrable ways to alter disease progression which could potentially prevent atrial fibrillation (AF) and its complications. We sought whether impaired functional capacity was associated with risk of AF, independent of myocardial dysfunction. In this community-based study, asymptomatic participants aged ≥65years were recruited if they had ≥1 risk factor (e.g., hypertension, diabetes mellitus, and obesity). Participants underwent baseline echocardiography (including measurement of myocardial mechanics) and six-minute walk test. The CHARGE-AF score was used to calculate 5-year risk of developing AF. Receiver operating characteristic curves were used to assess for independent risk factors for AF. A total of 607 patients (age 71 ± 5years, men 47%) were studied at baseline and followed for at least 6months. Patients in the higher AF risk groups were older and had increased rates of hypertension, diabetes mellitus, and ischemic heart disease (p <0.05). Greater AF risk was associated with lower exercise capacity, independent of lower mean global longitudinal strain, global circumferential strain, greater mean E/e' ratio, indexed left atrial volume and LV mass. Multivariate linear regression confirmed association of LV and functional capacity parameters with AF risk. Although functional capacity is impaired in AF, this association precedes the onset of AF. In conclusion, poor functional status is associated with AF risk, independent of LV function.