Resection Of Myxoma Research Articles

Stenotrophomonas Maltophilia Pneumonia in a COPD Patient with Left Atrial Myxoma: A Case of Rare Clinical Presentation

Stenotrophomonas maltophilia (S.maltophilia) is an emerging multidrug-resistant pathogen, often implicated in respiratory infections in patients with chronic lung disease. The present case report presents a unique association between S. maltophilia pneumonia and an incidental left atrial myxoma, contributing to respiratory distress. Hereby, the authors present a case report of a 52-yearold male with Chronic Obstructive Pulmonary Disease (COPD) presented with bilateral lower limb oedema, progressive dyspnoea, productive cough, and intermittent fever for 15 days. Upon admission, he exhibited tachycardia, tachypnoea, and hypoxaemia (SpO2 88% on room air). Chest examination revealed bilateral wheezing and crackles. Investigations showed leukocytosis, elevated inflammatory markers, and an abnormal chest X-ray with fibrotic changes and minimal pleural effusion. Echocardiography identified a 3.5 cm left atrial myxoma prolapsing into the mitral valve, along with severe pulmonary hypertension. Contrast-enhanced CT (CECT) confirmed the myxoma and revealed emphysematous and pneumonic changes. The patient was initially managed as a case of acute community-acquired pneumonia with acute decompensated heart failure using broad-spectrum antibiotics, bronchodilators, steroids, and diuretics. Due to respiratory distress and type 2 respiratory failure, Bilevel Positive Airway Pressure (BIPAP) support was initiated. Sputum culture identified S. maltophilia, which was sensitive to Trimethoprim-Sulfamethoxazole (TMP-SMX), leading to a targeted antibiotic regimen. The patient showed significant clinical improvement, allowing for weaning from BIPAP and oxygen support. Once stabilised, he was referred for surgical resection of the left atrial myxoma. The present case emphasises the importance of early recognition and targeted treatment of S. maltophilia pneumonia in COPD patients. Additionally, it highlights the role of comprehensive cardiovascular assessment in patients with persistent respiratory symptoms.

A male patient with atrial myxoma and multiple metastatic intracranial aneurysms: A case report and literature review.

Atrial myxoma is the most common primary benign tumor of the heart, with over 75% occurring in the left atrium. The migration of myxoma cells can lead to rare neurological complications such as intracranial aneurysms, embolic strokes, and arteriovenous malformations. The most common neurological manifestations in such patients include seizures, nonspecific headaches, and cerebrovascular events. Herein, we present a rare case of a middle-aged man in his early 50s with metastatic myxomatous multiple fusiform aneurysms, who initially presented with the clinical manifestation of intracerebral hemorrhage. The patient underwent atrial myxoma resection, whereas the intracranial multiple fusiform aneurysms were managed conservatively. Four years later, digital subtraction angiography revealed progressive enlargement of the aneurysm in the A3 segment of the left anterior cerebral artery. We present the pathological report of the atrial myxoma and imaging findings showing the changes in the aneurysms, along with a review and summary of the relevant literature. This report offers new insights into treatment options for cases of atrial myxoma complicated with intracranial multiple aneurysms. This is the first reported case of a male patient in China presenting with intracerebral hemorrhage as the initial manifestation of atrial myxoma combined with multiple fusiform aneurysms.

Left Ventricular to Right and Left Atrial Shunts Post–Myxoma Resection: A Multimodality Imaging Perspective

Left Ventricular to Right and Left Atrial Shunts Post–Myxoma Resection: A Multimodality Imaging Perspective

Clinical characteristics and surgical outcomes following cardiac myxoma resection.

Cardiac myxomas are the most common primary cardiac neoplasm (30-50%) with clinical incident of 0.5/ million population. Tranthoracic echocardiography remains the investigation of choice. Surgical excision is curative. The present study aims to analyze demographic and clinical characteristics as well as surgical outcomes in terms of mortality and recurrence of cardiac myxoma. Thirty patients of cardiac myxoma who met the inclusion criteria during study period study period, January-2018 to April-2024 were included. Data was analyzed for demographic characteristics, echocardiographic findings of myxoma and associated valve lesion, associated valve surgery and survival outcome. Of all subjects, 83.33% presented with dyspnea. Majority of myxoma, 76.67% were attached to interatrial septum. Overall survival at 1- and 3- year was 91.23%. Recurrence free survival at 1-, 3- years and end of this study were 100%, 84.71% and 84.71% respectively. Myxomas with valvular incompetence are rare entity and there is paucity of data and evidences recommending concomitant valve intervention in such cases. There were no immediate peri-operative deaths, however, in contrast to other studies; surgical site infection was the most common post operative complication. Overall survival at 1- and 3- year was 91.23%. Recurrence free survival at 1-, 3- years and end of this study were 100%, 84.71% and 84.71% respectively. Recurrence occurred in first- and third-year following surgery. Study highlights decent outcomes following cardiac myxoma resection. Case specific concomitant valve intervention spiral the success of surgery.

Total endoscopic resection of left atrial myxoma

Total endoscopic resection of left atrial myxoma

Successful surgical resection of tricuspid valve myxoma under cardiopulmonary bypass in a dog.

A 5-year-old, 7.6-kg male miniature dachshund presented with right-sided congestive heart failure and ascites. Echocardiography revealed a tricuspid valve tumor. Open-heart surgery with cardiopulmonary bypass was performed via right atriotomy and the tumor was excised from the septal leaflet of the tricuspid valve. Histopathological findings confirmed the diagnosis of a myxoma. Postoperatively, the ascites resolved and no signs of right-sided congestive heart failure were observed. The dog remained clinically stable for 727 days after surgery. This conclusion reinforces the novelty of this report, as successful resection of a tricuspid valve myxoma has not been reported in the veterinary literature.

Sequelae and Surgical Management of Giant Cardiac Myxoma

Abstract Cardiac myxomas are a rare phenomenon within the general population, and although there are reports of them, giant myxomas are not common in the medical literature. This report presents a case of a giant left atrial cardiac myxoma in a 57-year-old female patient who was largely asymptomatic until she presented with a diffuse thromboembolic stroke. This case report highlights the importance of surgical management of cardiac myxomas and discusses the difference in open vs minimally invasive surgical resection of giant cardiac myxomas.

Diagnosis and Optimal Surgical Treatment Strategy Selection for Asymptomatic Large Cardiac Myxomas: Review of Modern Approaches and Own Clinical Case Presentation

Cardiac myxoma (CM) is the most common primary tumor of the heart and can be asymptomatic for a long time. CMs have an increased risk of systemic embolization, intracardiac obstruction, transient ischemic attacks, and strokes, potentially leading to patient disability and/or sudden cardiac death. The aim. To highlight the data of modern scientific literature and demonstrate a case of plastic reconstruction of the heart after resection of a large tumor. Materials and methods. We report a case of incidentally discovered left atrial myxoma in a 67-year-old woman with no significant medical history. Transthoracic echocardiography revealed a large mass located in the left atrium. An open surgical intervention was performed, during which the giant CM was completely removed. Histopathological examination confirmed the diagnosis. The patient was discharged on the 7th day of the postoperative period without any complaints. Also, we carried out a comprehensive search and analysis of previously published cases of asymptomatic myxomas and methods of their surgical treatment in the scientific literature of the main electronic databases. Results. In our proposed report, a satisfactory clinical outcome was obtained in a patient with giant myxoma who underwent open cardiac surgery. According to the current literature, transthoracic echocardiography, computed tomography and magnetic resonance imaging of the heart are the gold standards for the diagnosis of heart neoplasms, which corresponded to our diagnostic algorithm. In the opinion of most specialists, the minimally invasive approach is a promising and attractive treatment method for surgeons, however, a complete median sternotomy remains the standard approach in patients with CMs. Conclusions. Asymptomatic CM is a rare incidental finding with a high probability of serious adverse cerebral and cardiovascular events. Early diagnosis of CM is crucial to prevent life-threatening complications, and the most valuable tool is transthoracic echocardiography. The strategy of surgical treatment varies depending on their size and anatomical localization, in particular, resection of large and septal myxomas is usually performed through median sternotomy.

Neurological complications of left atrial myxoma: a case report on stroke with left atrial myxoma and postoperative brain metastasis and cerebral aneurysm

Atrial myxoma is a rare benign tumor that can cause a variety of complications, including cerebral infarction. We present a case of a 52-year-old female patient who developed cerebral infarction caused by an atrial myxoma. The patient underwent successful surgical resection of the tumor, and the infarction was managed accordingly. However, 15-months post-surgery, the patient developed new neurological symptoms. Imaging studies revealed multiple cerebral metastases, consistent with the possibility of seeding of tumor cells. This rare complication emphasizes the importance of long-term monitoring after the resection of atrial myxomas. The occurrence of metastasis in the brain, though rare, should be considered in follow-up care, particularly in patients who have had embolic events related to atrial myxomas. Our case highlights the potential for cerebral myxoma metastasis even after initial successful surgical intervention, underscoring the need for comprehensive follow-up and vigilant monitoring of such patients.

Abstract 4140574: Echoes of Danger: A Case of Recurrent Atrial Myxoma with Cerebral Embolization

Introduction: Atrial myxomas are cardiac tumors that can cause arterio-occlusive diseases due to embolization of myxomatous fragments. Treatment is through prompt surgical resection, with recurrence rates relatively rare. Herein, we present a case of recurrent left atrial myxoma with hemorrhagic, cerebral embolization. Case Report: A 34-year-old male presented with acute onset numbness and tingling of the left arm. He was vitally stable with unremarkable physical examination or bloodwork. CT Head showed multifocal brain metastases in the bilateral parietal and left frontal lobes. Brain MRI demonstrated multiple hemorrhagic masses throughout the cerebral hemispheres with vasogenic edema. The patient’s past medical history was pertinent for bilateral occlusion of the femoral and popliteal arteries, with workup revealing a left atrial myxoma that was surgically resected in 2005. The patient presented again in 2021 with right facial paresthesia and arm weakness. Brain MRI showed bilateral cortical and subcortical MCA ischemic strokes. TEE confirmed the recurrence of a left atrial myxoma, requiring a repeat sternotomy and resection. Since then, the patient was frequently hospitalized with seizures and strokes. Surveillance brain MRIs consistently demonstrated hemorrhagic masses of varying sizes and vasogenic edema, localized to the watershed territories of the cerebral arteries. The patient underwent left frontal craniotomy and resection of a left frontal lobe lesion in 2023, with pathology specimens representing organizing cerebral hemorrhage of unclear etiology. Repeat echocardiograms did not show recurrence of a myxoma. The overwhelming clinical opinion states that these are myxomatous metastasis from before the patient’s last cardiac surgery. Given the tumor burden and progressive nature of the disease, the patient was deemed inappropriate for neurosurgery or chemotherapy. Discussion: Recurrence after surgical resection of atrial myxomas is rare, with 0.5 cases reported per 1000-person years, and is mainly attributed to inadequate surgical resection. Limited research exists regarding malignant atrial myxomas. The prevailing hypothesis points to the neoplastic transformation of myxomatous emboli into malignant lesions. Our patient is a unique case of a recurrent atrial myxoma with symptomatic cerebral metastasis. This case highlights the importance of adequate resection of cardiac myxomas to prevent the malignant transformation of an otherwise benign tumor.

Early result of minimally invasive cardiac myxoma resection at University Medical Center, Ho Chi Minh City

Objective: The study aimed to evaluate various clinical and paraclinical characteristics, as well as early surgical outcomes of minimally invasive cardiac myxoma resection at University Medical Center HCMC. Subjects and methods: This is a retrospective descriptive case series study involving all patients diagnosed with cardiac myxomas who underwent minimally invasive surgery at University Medical Center HCMC from January 2020 to June 2024. Results: There were 31 patients, consisting of 22 females and 9 males. The mean age was 56,2 ± 10,7 years old (from 37 to 77 years old). The clinical manifestations were diverse: asymptomatic (45,2%), cerebral embolism (6,4%), fatigue (29,0%), dyspnea (35,5%), palpitations (12,9%), and dizziness (12,9%). Echocardiographic results: 90,3% left atrial myxoma, 9,7% right atrial myxoma. The tumor attachment sites: interatrial septum (93,6%), left atrial wall (6,4%). The average tumor size was 36,3 ± 15,1 mm. All tumors were completely resected (100%). Additional surgical procedures: mitral valve repair (3,2%), interatrial septum repair (6,4%). Cardiopulmonary bypass time was 82,4 ± 31,1 minutes (from 49 to 199 minutes), cross - clamp time was 39,2 ± 17,6 minutes (from 18 to 85 minutes), with 3 cases not requiring cardiac arrest. Ventilation time was 13,2 ± 6,3 hours (from 6,7 to 32,4 hours), intensive care unit stay was 52,6 ± 28,1 hours (from 13 to 113,7 hours), postoperative recovery time was 6,9 ± 2,3 days (from 4 to 16 days). Early outcomes: 3 cases of atrial fibrillation with rapid ventricular response, treated medically (9,7%), 1 case of acute kidney injury (3,2%), 4 cases of pleural effusion (12,9%), 3 cases of pneumothorax (9,7%), 1 case of right external iliac artery thrombosis requiring surgical thrombectomy (3,2%), and 2 cases of deep vein thrombosis (6,4%). No surgical site infections, cerebrovascular accidents, or mortality within 30 days post-surgery were reported. Conclusion: Minimally invasive cardiac myxoma resection demonstrates a low complication rate, with no reported tumor recurrence or early postoperative mortality. This technique offers a safe and effective alternative to traditional median sternotomy and may be gradually adopted and implemented in lower - level healthcare facilities.

Myxoma and Carotid Artery Occlusion Finding During a Stroke : The tree that hides the forest

57-year-old female patient, who is an active smoker, admitted for a left-sided ischemic stroke in whom we found an association of a chronic occlusion of the left internal carotid and a myxoma of the left atrium, who presented a new onset stroke a month after the myxoma resection.

6564 A Case of Severe Hypercalcemia in Carney's Complex

Abstract Disclosure: J. Chippior: None. M. Rayan: None. L. Wright: None. L.S. Kirschner: Grant Recipient; Self; Medpace, Sparrow, Corcept Therapeutics, Corcept, Spruce, CinCor, Crinetics, Adrenas. S.W. Ing: Grant Recipient; Self; Alexion Pharmaceuticals, Inc., Amgen Inc, Radius Health, Inc, Takeda, Ultragenyx, Amolyt, Bridge Bio. Carney complex is a rare syndrome with fewer than 750 reported cases, characterized by lentigniosis, myxomas, and the occurrence of both endocrine and non-endocrine tumors. An inactivating mutation PRKAR1A, which encodes for the type 1A regulatory subunit of Protein kinase A, is responsible for over 70% of familial cases and 37% of sporadic cases. A 31-year-old female with a history of Carney complex, Cushing syndrome due to primary pigmented nodular adrenocortical disease (PPNAD), facial lentigines, spinal Schwannomas, and recent ischemic stroke secondary to embolization of a cardiac atrial myxoma, was transferred to our medical center for hyperemesis and severe hypercalcemia. Albumin-corrected serum calcium measured 15.4 mg/dL (8.6-10.5 mg/dL), ionized calcium 7.8 mg/dL (4.6-5.3 mg/dL) associated with suppressed PTH, normal PTH-related protein, and elevated bone turnover markers, C-telopeptide 4,273 pg/ml (150-635) and Procollagen Type 1 N-terminal Propeptide 222 mcg/L (19-83). Evaluation for etiology of hypercalcemia revealed elevated 1,25 dihydroxy vitamin D at 107.0 pg/ml (20-79) and elevated interleukin-6 at 11 pg/ml (<6.4). IL-6 is expressed by cardiac myxomas. Serum angiotensin-converting enzyme level was 50 U/L (16-85) and infectious workup was negative for potential granulomatous causes of elevated calcitriol (including testing for tuberculosis, histoplasma, blastomyces, bartonella, and coccidioides). CT angiogram of the abdomen and pelvis (completed in preparation of atrial myxoma resection) revealed ground-glass opacities in bilateral posterior lung fields and multiple pulmonary nodules, with the largest measuring 8 mm. After treatment with aggressive intravenous fluid resuscitation, intramuscular calcitonin, and intravenous zoledronic acid, corrected calcium normalized to 9.4 mg/dL at discharge. Urinary cortisol was 6.2 mcg per 24-hr (3.5-45), for which she started hydrocortisone 20 mg daily to treat suspected adrenal insufficiency as excess cortisol secretion in PPNAD may be episodic. Thus remission of hypercortisolism may have unmasked an underlying hypercalcemia, and adrenal insufficiency itself may have contributed to this finding. She had excision of left atrial myxoma and has continued to exhibit normal calcium levels on steroid replacement therapy. Repeat chest CT to further characterize these pulmonary findings is planned. This case illustrates a unique constellation of endocrine features associated with severe hypercalcemia in Carney complex. Presentation: 6/1/2024

6564 A Case Of Severe Hypercalcemia In Carney's Complex

Abstract Disclosure: J. Chippior: None. M. Rayan: None. L. Wright: None. L.S. Kirschner: Grant Recipient; Self; Medpace, Sparrow, Corcept Therapeutics, Corcept, Spruce, CinCor, Crinetics, Adrenas. S.W. Ing: Grant Recipient; Self; Alexion Pharmaceuticals, Inc., Amgen Inc, Radius Health, Inc, Takeda, Ultragenyx, Amolyt, Bridge Bio. Carney complex is a rare syndrome with fewer than 750 reported cases, characterized by lentigniosis, myxomas, and the occurrence of both endocrine and non-endocrine tumors. An inactivating mutation PRKAR1A, which encodes for the type 1A regulatory subunit of Protein kinase A, is responsible for over 70% of familial cases and 37% of sporadic cases. A 31-year-old female with a history of Carney complex, Cushing syndrome due to primary pigmented nodular adrenocortical disease (PPNAD), facial lentigines, spinal Schwannomas, and recent ischemic stroke secondary to embolization of a cardiac atrial myxoma, was transferred to our medical center for hyperemesis and severe hypercalcemia. Albumin-corrected serum calcium measured 15.4 mg/dL (8.6-10.5 mg/dL), ionized calcium 7.8 mg/dL (4.6-5.3 mg/dL) associated with suppressed PTH, normal PTH-related protein, and elevated bone turnover markers, C-telopeptide 4,273 pg/ml (150-635) and Procollagen Type 1 N-terminal Propeptide 222 mcg/L (19-83). Evaluation for etiology of hypercalcemia revealed elevated 1,25 dihydroxy vitamin D at 107.0 pg/ml (20-79) and elevated interleukin-6 at 11 pg/ml (<6.4). IL-6 is expressed by cardiac myxomas. Serum angiotensin-converting enzyme level was 50 U/L (16-85) and infectious workup was negative for potential granulomatous causes of elevated calcitriol (including testing for tuberculosis, histoplasma, blastomyces, bartonella, and coccidioides). CT angiogram of the abdomen and pelvis (completed in preparation of atrial myxoma resection) revealed ground-glass opacities in bilateral posterior lung fields and multiple pulmonary nodules, with the largest measuring 8 mm. After treatment with aggressive intravenous fluid resuscitation, intramuscular calcitonin, and intravenous zoledronic acid, corrected calcium normalized to 9.4 mg/dL at discharge. Urinary cortisol was 6.2 mcg per 24-hr (3.5-45), for which she started hydrocortisone 20 mg daily to treat suspected adrenal insufficiency as excess cortisol secretion in PPNAD may be episodic. Thus remission of hypercortisolism may have unmasked an underlying hypercalcemia, and adrenal insufficiency itself may have contributed to this finding. She had excision of left atrial myxoma and has continued to exhibit normal calcium levels on steroid replacement therapy. Repeat chest CT to further characterize these pulmonary findings is planned. This case illustrates a unique constellation of endocrine features associated with severe hypercalcemia in Carney complex. Presentation: 6/1/2024

Comparative analysis of robotically-assisted versus conventional sternotomy approach in left atrial-myxoma resection: A single-center retrospective observational study

Comparative analysis of robotically-assisted versus conventional sternotomy approach in left atrial-myxoma resection: A single-center retrospective observational study

Cerebral Embolism and MINOCA Secondary to Left Atrial Myxoma after Occlusion of Atrial Septal Defect by Amplatzer Occluder: A Case Report.

Primary heart tumors are rare, with atrial myxomas being the most common type. Atrial myxomas can lead to embolisms, heart obstruction, and systemic symptoms. Herein, we report a case of 72-year-old woman who presented with a left atrial myxoma at the atrial septal defect occluder, a new acute cerebral infarction, and MINOCA (myocardial infarction with no obstructive coronary atherosclerosis). Left atrial myxoma is a common primary cardiac tumor; however, left atrial myxomas arising after percutaneous atrial septal defect occlusion are rare. Additionally, the patient presented with a new case of multiple systemic emboli. The patient underwent surgical resection of a left atrial myxoma, occluder, and left atrium, and atrial septal repair, and was discharged with good recovery for outpatient follow-up. The possibility of a cardiac tumor, especially an atrial myxoma, which can lead to a series of complications, should be considered at the closure site after percutaneous atrial septal closure. Therefore, active surgical treatment and long-term follow-up are warranted in such cases.

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

Clinical characteristics, diagnostic methods and results of surgically treated histologically benign cardiac myxomas.

Myxomas are primary cardiac tumours that may be detected incidentally due to embolic events, intracardiac obstructive features or non-specific structural symptoms. The aim of this study was to share our experience of clinical features, diagnostic methods, surgical procedures and postoperative follow up of surgically treated cardiac myxomas. Data of 34 patients who underwent surgery for a cardiac myxoma between January 2006 and June 2022 were retrospectively analysed. Group 1 (n = 19) consisted of patients who were symptomatic and group 2 ( n = 15) patients were asymptomatic. The medical records of the patients, their clinical status, diagnostic methods, operation information and postoperative course data were collected and recorded. A total of 34 patients (16 female; mean age 54.5 ± 8.8 years) underwent cardiac myxoma resection with cardiopulmonary bypass. Fifteen (44.1%) patients were diagnosed incidentally with asymptomatic myxoma. An additional cardiac surgical procedure was performed in six patients (17.7%). The 34 cardiac myxomas that were surgically resected were localised in the left atrium in 25 patients (73.5%) and in the right atrium in nine patients (26.5%). Patients' most common symptoms were dyspnoea (42.1%), palpitations (21.1%), ischaemic stroke (15.8%) and syncope (10.5%). There was no incident of 30-day mortality and no recurrence was observed in any patient during the follow-up period. The duration of surgical intervention in symptomatic patients was significantly shorter than in asymptomatic patients (p = 0.0001), but there was no statistical difference in terms of characteristics. Myxomas are benign tumours, but they are serious pathologies that require early treatment because of signs of obstruction, embolic complications and confusion, with left atrial thrombus in the differential diagnosis.

Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon’s learning curve experience

Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon’s learning curve experience

Surgical experience in cardiac myxomas at a tertiary hospital

Surgical experience in cardiac myxomas at a tertiary hospital