Giant Left Atrial Myxoma Presenting with Cough-Syncope Syndrome
Myxoma and Cough-Syncope Syndrome
DOI:
https://doi.org/10.1532/hsf.3991Keywords:
Cough- Syncope Syndrome, Myxoma, Syncope AttacksAbstract
We report the case of a 41-year-old female patient with symptoms of cerebrovascular accident manifesting with loss of consciousness during episodes of cough. Computed multislice chest tomography showed a 7.3- by 4.15-cm mass in the left atrium. A transesophageal echocardiogram showed a giant mass in the left atrium that passed through the mitral valve to the left ventricle, and severe obstructive stenosis was suggested by the mean transmitral gradient. After a comprehensive assessment of the mass, we decided to perform surgery. The pedunculated and fragile mass was attached to the interatrial septum with its handle, and the majority of it prolapsed through the mitral valve to the left ventricle and became stacked among the mitral valve leaflets. The removed mass was analyzed histopathologically and was found to be a myxoma. It is important for the cardiac surgeon to surgically remove an atrial myxoma because of the risks associated with embolization, including sudden death, as myxoma can block the blood supply from the atrium to the ventricle.
References
Abu Abeeleh M, Saleh S, Alhaddad E, et al. Cardiac myxoma: clinical characteristics, surgical intervention, intra-operative challenges and outcome. Perfusion 2017;32:686-690.
Agmon Y, Khandheria BK, Gentile F, Seward JB. Echocardiographic assessment of the left atrial appendage. J Am Coll Cardiol 1999;34:1867-1877.
Amoah AGB, Frimpong-Boateng K, Kallen C, Barwasser HM. Atrial myxoma—a case report and review of the literature. West Afr J Med 1988;17:50-54.
Bowman JN, Treece JM, Bhattad PB, Bochis M, Bajaj K. Giant left atrial myxoma masquerading as cough-syncope syndrome. J Invest Med High Impact Case Rep 2017;11:1-5.
Gur AK, Kaya Y, Karakurt A, Güvenç TS. Miksoma ve fibroelastomanın eşlik ettiği Carney sendromlu hasta. Dicle Med J 2012;39:413-415 [in Turkish].
Keeling IM, Overwalder P, Anelli-Monti M, et al. Cardiac myxomas: 24 years of experience in 49 patients. Eur J Cardiothorac Surg 2002;22:971-977.
Kimberly H, Stone M. Elderly man with acute respiratory distress. Ann Emerg Med 2016;67:319-331.
Levy S. Atrial fibrillation, the arrhythmia of the elderly, causes and associated conditions. Anadolu Kardiyol Derg 2002;2:55-60.
Ojji DB, Ajiduku SS, Omonua OO, Abdulkareem LL, Parsonage W. A probable right atrial myxoma prolapsing through the tricuspid valve into the right ventricle: a case report. Cases J 2008;1:386.
Poterucha TJ, Jonathan Kochav J, O’Connor DS, Rosner GF. Cardiac tumors: clinical presentation, diagnosis, and management. Curr Treat Options Oncol 2019;20:66.
Rajani AR, Muaz RN, Govindaswamy PR, Mian MH. Arryhmias are not to blame for all cardiac syncope patients: left atrial myxoma causing syncope in a middleaged man. BMJ Case Rep 2015; 2015:bcr2014209119.
Rashidi N, Montazeri M, Montazeri M. Large left atrial myxoma causing mitral valve obstruction: a rare cause of syncope. J Cardiovasc Echogr 2014;24:125-127.
Rathore KS, Hussenbocus S, Stuklis R, Edwards J. Novel strategies for recurrent cardiac myxoma. Ann Thorac Surg 2008;85:2125-2126.
Salcedo EE, Cohen GI, Write RD, Davison M. Cardiac tumors. diagnosis and management. Curr Probl Cardiol 1992;17:73-137.
Sheu CC, Lin SF, Chiu CC, et al. Left atrial sarcoma mimicking obstructive pulmonary disease. J Clin Oncol 2007;25:1277-1279.
Strecker T, Agaimy A. Giant left atrial myxoma causing drop attacks by prolapsing into the mitral valve. Int J Clin Exp Pathol 2012;5:996-999.
Suraj M, Pressman GS, Figueredo WM. Primary cardiac tumors. Int J Cardiol 2009;133:152-156.
Wintersperger BJ, Becker CR, Gulbins H, et al. Tumors of the cardiac valves: imaging findings in magnetic resonance imaging, electron beam computed tomography, and echocardiography. Eur Radiol 2000;10:443-449.
Yamada T, Hirose H, Umeda S, Murakawa S, Mori Y, Iwata H. Right ventricular myxoma – case report and review of the literature. Nippon Kyobu Geka Gakkai Zasshi 1993;41:1069-1107.
Ying L, Lin R, Gao Z, Qi J, Zhang Z, Gu W. Primary cardiac tumors in children: a center’s experience. J Cardiothorac Surg 2016;11:52.
Yuan SM. Cerebral infarction due to cardiogenic emboli originating from atrial myxoma: a case report. Changhua J Med 2014;12:87-92.
Yuan SM, Wang SG. Cardiac myxoma presenting as vertigo and paresthesia of the extremities. Acta Med Mediterr 2014;29:105-109.
