Surgical Resection of Left Atrial Myxoma Presenting with Acute Multiple Hemorrhagic Cerebral Infarctions: A Case Report

  • Michael G. Katz
  • Vitaly Finkelshtein
  • Dominique Ben-Ami Raichman
  • Hagi Dekel
  • Yair Lampl
  • Lior Sasson


Brain ischemia resulting from left atrial myxoma embolization has been well documented. In contrast, the link between the development of intracerebral hemorrhage and myxoma in these patients has little coverage in the literature. The main theory describing this relationship stems from the fact that cardiac myxoma cells metastasize to the brain's vessels, causing destruction of the arterial wall with subsequent formation of fusiform aneurysm and further intracranial bleeding. It is assumed that when a diagnosis of left atrial myxoma with neurologic manifestations is made, surgical resection should be performed without delay to prevent repeated tumor embolization; however, systemic anticoagulation treatment during cardiac surgery with cardiopulmonary bypass is not recommended immediately after intracerebral hemorrhage occurs because of the possibility of extending the infarct's size. We describe a patient with acute hemorrhagic brain infarction and an echocardiographically demonstrated left atrial myxoma that was surgically resected successfully in the acute phase after the onset of the neurologic symptoms.


Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. 1995. Surgical management of infective endocarditis associated with cerebral complications. J Thorac Cardiovasc Surg 110:1745-55.\nFuruya K, Sasaki T, Yoshimoto Y, Okada Y, Fujimaki T, Kirino T. 1995. Histologically verified cerebral aneurysm formation secondary to embolism from cardiac myxoma: case report. J Neurosurg 83:170-3.\nHerbst M, Wattjes MP, Urbach H, et al. 2005. Cerebral embolism from left atrial myxoma leading to cerebral and retinal aneurysms: a case report. AJNR Am J Neuroradiol 26:666-9.\nYamamoto S, Shichijo T, Yamane K, Terasaka K. 2007. Left atrial myxoma surgically resected in acute phase of hemorrhagic cerebral infarction: report of a case [in Japanese]. Kyobu Geka 60:237-41.\nZisbrod Z, Rose DM, Jacobowitz IJ, Kramer M, Acinapura AJ, Cunningham JN. 1987. Results of open heart surgery in patients with recent cardiogenic embolic stroke and central nervous system dysfunction. Circulation 76:V109-12.\nBays S, Nicholson E, Humphreys N, Parry A. 2004. Aortic root replacement after recent intracerebral hemorrhage. Eur J Cardiothorac Surg 26:863-5.\nBurke AP, Virmani R. 1993. Cardiac myxoma: a clinicopathologic study. Am J Clin Pathol 100:671-80.\nSabolek M, Bachus-Banaschak K, Bachus R, Arnold G, Storch A. 2005. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review. Acta Neurol Scand 111:345-50.\nSuzuki T, Nagai R, Yamazaki T, et al. 1994. Rapid growth of intracranial aneurysms secondary to cardiac myxoma. Neurology 44:570-1.\nSwartz MF, Lutz CJ, Chandan VS, Chandan VS, Landas S, Fink GW. 2006. Atrial myxomas: pathologic types, tumor location, and presenting symptoms. J Card Surg 21:435-40.\n
How to Cite
Katz, M., Finkelshtein, V., Raichman, D., Dekel, H., Lampl, Y., & Sasson, L. (2008). Surgical Resection of Left Atrial Myxoma Presenting with Acute Multiple Hemorrhagic Cerebral Infarctions: A Case Report. The Heart Surgery Forum, 11(3), E169-E171.