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Case Reports
. 2008;35(2):193-5.

Biatrial myxoma and cerebral ischemia successfully treated with intravenous thrombolytic therapy and surgical resection

Morhaf Ibrahim  1 , Cezar Iliescu, Hazim J Safi, Maximilian L Buja, David D McPherson, Francisco Fuentes
Affiliations
Case Reports

Biatrial myxoma and cerebral ischemia successfully treated with intravenous thrombolytic therapy and surgical resection

Morhaf Ibrahim et al. Tex Heart Inst J. 2008.

Abstract

We report what we believe is the 1st case in the medical literature in which an intravenous thrombolytic agent was used successfully--without massive intracranial bleeding--to treat acute stroke induced by atrial myxoma. Our patient, who had biatrial myxomas with a dual blood supply from the right coronary artery, presented with cerebral ischemia. Transesophageal echocardiography was essential in clarifying the diagnosis and in helping to direct surgical treatment.

Keywords: Cerebrovascular accident; echocardiography, transesophageal; embolism; heart atria/surgery; heart neoplasms/complications/diagnosis/surgery; intracranial embolism and thrombosis/etiology/drug therapy; myxoma; thrombolytic therapy; tissue plasminogen activator.

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Figures

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Fig. 1 A transesophageal echocardiogram (mid-esophageal position, long-axis view) shows a left atrial myxoma prolapsing through the mitral valve. Real-time motion images are available at texasheart.org/journal
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Fig. 2 A transesophageal echocardiogram (mid-esophageal position, bicaval view) shows atrial myxomas on both the left and right aspects of the interatrial septum. Real-time motion images are available at texasheart.org/journal
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Fig. 3 Right coronary angiogram (left anterior oblique view) shows the independent arterial supply for each tumor (note “tumor blush”): arrow A, the proximal right coronary artery; arrow B, the left atrial myxoma and the distal right coronary artery (posterolateral branch); and arrow C, the right atrial myxoma. Real-time motion images are available at texasheart.org/journal
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Fig. 4 Photomicrograph of the biopsy specimen shows cords of small-to-medium tumor cells (1) containing eosinophilic cytoplasm within an abundant myxoid stroma (2) (H&E, orig. ×40).
See this image and copyright information in PMC

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