Atrial myxoma

A 72-year-old woman, who underwent emergency resection of a giant left atrial myxoma, had pulmonary hypertension (pulmonary artery pressure 40 mmHg) and a low cardiac output (2.21/minute). Inhaled nitric oxide, 40 ppm, before cardiopulmonary bjrpass resulted in pulmonary vasodilatation and a fall in pulmonary artery pressure from 39 to 31 mmHg. This was accompanied by a fall in cardiac output from 2.4 to 1.5 1/minute and a fall in mixed venous oxygen saturation. After bypass, inhaled nitric oxide improved pulmonary and systemic hemodynamics and resulted in a rise in cardiac output from 3.0 to 3.5 l/minute. 

The authors concluded that inhaled nitric oxide had reduced pulmonary hypertension and pulmonary vascular resistance, but that obstruction by the atrial myxoma had caused the low cardiac output, due to a net reduction in transpulmonary pressure. 

Rovira I, Fita G, Suarez S, Gomar C, Cartana R. Effects of inhaled nitric oxide in a patient with pulmonary hypertension and left heart failure secondary to a giant left atrial myxoma. J Cardiothorac Vase Anesth 1999 13(6) 726-8. 

Atrial myxoma is a rare atrial tumor that causes multiple emboli of either thrombus or myxomatous tissue. When myxomatous material is embolized from the left atrium into the brain arteries, they may cause the formation of multiple distal cerebral aneurysms with risk of hemorrhage [46]. Papillary fibroelastomas are rare benign cardiac tumors usually involving a heart valve. They are small vascular growths with marked papillary projections. They usually grow on the aortic or mitral valves. The tumor consists of fibrous tissue surrounded by an elastic membrane, which in turn is covered by endothelium. One of the most conunon clinical presentations is of transient ischemic attack or stroke [47,48]. 

Johnson TR, Clevert DA, Busch S, Schweyer M, Nikolaou K, Reiser MF, Becker CR (2007) Evaluation of left atrial myxoma by dual-source CT. Cardiovasc Intervent Radiol 30 1085-1086 Millner MR, McDavid WD, Waggener RG, Dennis MJ, Payne WH, Sank VJ (1979) Extraction of information from CT scans at different energies. Med Phys 6 70-71... 

Cardiovascular In a case report, a 71-year-old male patient who underwent renal transplant 17 years prior and was on ciclosporin, azathioprine (AZA) and prednisone for immunosuppression developed atrial myxoma. It raised the possibility of association with ciclosporin use as there were four other case reports of atrial myxoma in patients... 

Singh P, B aj N, Agrawal G, Shanna A. Atrial myxoma-related to chronic immunosuppressioit a case report. J Saudi Heart Assoc October 2012 24(4) 265-7. PubMed PMID 24174836. Pubmed Central PMCID PMC3809469. Epub 2013/11/01. eng. 

Fig. 19.8a,b. A 52-year-old woman with a right atrial mass. MDCT shows a large filling defect in the right atrium (a) that was confirmed to be a myxoma after surgical removal (b)... 

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