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Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 81-82

A Giant Left Atrial Myxoma Causing Left Ventricular Inflow Obstruction and Mitral Regurgitation


Department of Cardiology, Calicut Medical College, Kozhikode, Kerala, India

Date of Submission17-Aug-2020
Date of Acceptance23-Nov-2020
Date of Web Publication05-Apr-2021

Correspondence Address:
Dr. Jomy Vadasseril Jose
Department of Cardiology, Calicut Medical College, Kozhikode - 673 008, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_50_20

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How to cite this article:
Desabandhu V, Jose JV. A Giant Left Atrial Myxoma Causing Left Ventricular Inflow Obstruction and Mitral Regurgitation. J Indian Acad Echocardiogr Cardiovasc Imaging 2021;5:81-2

How to cite this URL:
Desabandhu V, Jose JV. A Giant Left Atrial Myxoma Causing Left Ventricular Inflow Obstruction and Mitral Regurgitation. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2021 [cited 2021 Jul 23];5:81-2. Available from: https://www.jiaecho.org/text.asp?2021/5/1/81/313089

A 60-year-old male patient presented with progressive dyspnea for the past 6 months with symptoms at rest for the last 10 days. On examination, there was a short systolic murmur along with a mid-diastolic rumble at the apex. Subsequently, he underwent transthoracic and transesophageal echocardiography, which revealed a giant pedunculated left atrial (LA) myxoma of 5.5 cm × 2.2 cm size, attached to the interatrial septum (IAS) and prolapsing into the left ventricle during diastole. Doppler interrogation of the mitral valve revealed turbulence across the valve with mitral regurgitation [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5] and [Video 1],[Video 2],[Video 3],[Video 4]. The mechanism of mitral valve regurgitation, in this case, could probably be due to the injury caused by the huge myxoma hitting on the mitral valve leaflets. Alternatively, it could be due to poor coaptation of the leaflets caused by the prolapsing tumor. The patient was taken up for early surgery. Via a median sternotomy, the right atrium was opened and the LA was approached through IAS. An ellipsoid huge mass of size 5 cm × 4 cm with a small peduncle at the fossa ovalis was found. The whole mass was excised [Figure 6]. The mitral valve was inspected for the need of repair but was found to be satisfactory.
Figure 1: A modified mid-esophageal long-axis view during transesophageal echocardiography revealing the myxoma of size 5.5 cm × 2.2 cm prolapsing into the left ventricular during diastole

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Figure 2: Transesophageal echocardiography; color Doppler in a modified mid-esophageal long-axis view showing the myxoma almost fully obstructing the left ventricular inflow allowing only a thin jet across the mitral valve at end-diastole

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Figure 3: Transesophageal echocardiography; color Doppler in a modified mid-esophageal long-axis view showing mitral regurgitation

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Figure 4: Transesophageal echocardiography; a mid-esophageal fourchamber view showing the attachment of the myxoma to the interatrial septum at the fossa ovalis

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Figure 5: Transesophageal echocardiography; a mid-esophageal shortaxis view showing the small pedicle of the myxoma attached to the interatrial septum at the fossa ovalis

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Figure 6: Gross specimen of the myxoma after excision from the left atrium

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Video 1: A modified mid-esophageal long-axis view during transesophageal echocardiography revealing the myxoma of size 5.5 × 2.2 cm prolapsing into the left ventricle during diastole.

[Additional file 1]

Video 2: Colour Doppler in a modified mid-esophageal long-axis view during transesophageal echocardiography showing the myxoma almost fully obstructing the left ventricle inflow allowing only a thin jet across the mitral valve at end-diastole.

[Additional file 2]

Video 3: A mid-esophageal four-chamber view during transesophageal echocardiograph showing the attachment of the myxoma to the interatrial septal at the fossa ovalis.

[Additional file 3]

Video 4: A mid-esophageal short-axis view during transesophageal echocardiography showing the small pedicle of the myxoma attached to the interatrial septum at the fossa ovalis.

[Additional file 4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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