Atrial myxoma- A case report with review of literature

Atrial myxoma is the most common primary cardiac neoplasm. It is a tumor of adults, most often seen in women aged 20 to 60 years. Most commonly arise in isolated fashion (90%) but few (10%) can be associated with carney complex (myxoma syndrome) an autosomal dominant disease seen in younger age group. Left sided myxomas present signs of mitral stenosis or insufficiency and right sided tumors with dyspnea, syncope, distension of neck veins is seen. Two dimensional echocardiography, CT, MRI, gated radionuclide blood-pool scan, or cardiac catheterization can all visualize myxomas, but cannot differentiate between other pedunculated tumors or thrombi. It is important to rule out Carney complex because chances of recurrence are much higher than when compared to non syndromic myxomas. Hereby in this case report we discuss a large atrial myxoma in female who presented with breathlessness and chest pain.

P1306 A large cardiac mass of left sections in a young man

Background Heart tumors are very rare lesions. Their prevalence is about 0.001 to 0.03 % in an autopsy series. In most cases, primitive lesions are benign, with atrial myxomas that represent up to 2/3 of cases. Malignant neoplasms have a high mortality; sarcomas are the most frequent typologies. The most aggressive tumors are characterized by greater size, muscle invasion and pericardial effusion. Clinical case A 39-year-old man with recent history of worsening dyspnea went to the emergency room because of an aggravation of the symptoms. An echocardiogram showed a large atrial inhomogeneous mass, adherent to the mitral ring and involving both left atrial and ventricle, causing a severe valvular stenosis, suggestive for malignancy. Thus the patient performed a cardiac-MRI, confirming the neoplasm localization with parietal infiltration, pericardial extension and effusion. A total-body CT scan ruled out metastasis. The patient underwent heart surgery and a partial excision was performed. Macroscopically the tumor had a scirrhous consistency and a diameter of about 5 cm. The histologic examination showed a high-grade sarcoma with fused cells and with condrosarcomatous areas. Discussion The study of heart massesincludes the execution of echocardiographies as first-line examinations, while the in-depth diagnostics (necessary in the anticipation of surgery) require cardiac-MRI or CT. Malignant lesions are characterized by an inomogeneous appearance, with a wide plant base and sizes larger than 5 cm, they are also able to take contrast medium during diagnostic examinations. High grade neoplasms are rapidly evolving with a very severe prognosis. The symptoms are essentially due to the localization and the mass bulk. In our case, its development on the mitral valve caused severe hemodynamic impairment, requiring immediate intervention. The treatment of these lesions is necessarily surgical. The only positive prognostic factor is a complete excision of neoplasm with free resection margins. As the diagnosis is often not early, chemotherapy or radiotherapy are often required after surgery. Conclusion Cardiac masses are rare entities and their evaluation may be a diagnostic challenge. Myxoma represent the most common primary cardiac neoplasm in adults, while about 25% of other primary ones are malignant. Our patient was suffering from a sarcoma, whose incomplete debulking made further therapies necessary. The correct interpretation of instrumental findings together with a possible radical surgery are mandatory for a successful therapeutic strategy. Abstract P1306 Figure.

P680 Aortic arch myxoma with multiple peripheral embolism.

We report an unusual localisation of myxoma, the most common primary cardiac neoplasm. A 58-year-old woman was admitted to surgery department with exacerbation of abdominal discomfort and symptoms of lower limb claudication.The abdominal CT showed embolism in the upper mesenteric artery arms with intestinal ischemia, in the minor renal arteries with kidney infarcts and in the minor arteries of lower extremities. She was urgently, succesfully operated and partial resection of the small intestine was performed. The chest angio-CT conducted three days after the operation revealed additional structure in the aortic arch. Local aortic arch dissection with a thrombus was initially suspected. Echocardiography showed homogenous tumor on the minor curvature of the aortic arch, with a base of 11 mm of width, reaching down with the blood stream towards the descending aorta. The aortic wall was linear, with no signs of dissection or atherosclerotic lesions, echogenicity indicated rather solid mass. The patient was operated cardiosurgically and tumor of a myxoma type was confirmed intraoperatively. Another, small tumor of the same type was found below isthmus, in a descending aorta. Partial resection of aortic arch, alloplasty of aortic arch with the use of a dacron prosthesis were performed. The tumor below the isthmus was removed, without resection of aortic wall, due to the high risk associated with the widening of the procedure. Multimodality imaging with the essential role of echocardiography is useful especially in differential diagnostics of the atypically localized tumors causing diffuse peripheral embolization. Abstract P680 Figure. Aortic arch myxoma tumor