From the Département de Chirurgie (R.P.), Service de Cardiologie
(C.V., R.L.), and Division de Pathologie clinique (S.D.-B.), Hôpitaux
Universitaires de Genève, Switzerland.
Correspondence to René Prêtre, MD, Cardiovascular Surgery, University Hospital, 100 Rämistr, 8091 Zürich, Switzerland.
A
36-year-old man was admitted for investigation of night
sweats and increasing exertional dyspnea. On clinical examination, he
was afebrile, with normal blood pressure, regular cardiac rhythm,
and no signs of cardiac failure. Auscultation revealed a
holosystolic murmur, a diastolic rumbling, and an
early diastolic sound ("tumor plop"). Routine blood
tests were normal except for a sedimentation rate of 80 mm/h
(normal, <10 mm/h) and a platelet count at 430 000/L (normal
range, 150 000 to 300 000/L).
Echocardiography revealed a voluminous,
mobile, and spherical tumor in the left atrium attached to the
interatrial septum, suggesting myxoma. There was moderate mitral
regurgitation. Size, location, and motion of the tumor
were particularly well delineated by transesophageal
echocardiography with three-dimensional
reconstruction (Figure 1
The patient underwent resection of the myxoma and repair of the mitral
valve under cardiopulmonary bypass and moderate hypothermia.
The myxoma was a 7x5x5-cm tumor attached to the atrial septum, and it
was removed with part of the interatrial septum (Figure 3
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Three-dimensional Imaging of Atrial Myxoma
). The
echocardiographic findings were confirmed by MRI
(Figure 2).
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Figure 1. Three-dimensional transesophageal
echocardiography showing a left atrial mass
attached by stalk to interatrial septum, prolapsing through mitral
valve during ventricular diastole.
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Figure 2. MRI showing mass in left atrium prolapsing through
mitral valve during ventricular diastole. ). The atrial defect was closed with a
patch of autologous pericardium. Mitral regurgitation
was due to prolapse of the anterior leaflet. Shortening of elongated
chordae and ring annuloplasty restored valve competence, as assessed by
intraoperative transesophageal
echocardiography. Anatomicopathological
analysis (Figure 4) confirmed the
diagnosis of myxoma. The patient had an uneventful recovery and was
discharged on warfarin sodium, which was discontinued after 2 months.
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Figure 3. Macroscopic view of surgical specimen. Tumor was
resected with a piece of interatrial septum.
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Figure 4. Microscopic examination of tumor showing an
abundant stroma of glycosaminoglycan and dispersed,
isolated, or clustered polygonal cells consistent with a
cardiac myxoma (hematoxylin-eosin, x400).
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