Acute heart failure related to a large left atrial myxoma

Abstract

An association between atrial myxoma and left ventricular failure is rarely described, is not completely understood, and may have multiple etiologies. We present a 49-year-old man with no history of cardiovascular disease who was admitted to our hospital with pulmonary edema. He was in atrial fibrillation with rapid ventricular response. Echocardiography showed a 10.5-cm left atrial myxoma, which had been asymptomatic until the onset of congestive heart failure in the presence of severe left ventricular systolic dysfunction. Left ventricular inflow obstruction associated with the giant atrial mass could not be the only cause for acute heart failure.

Keywords: Atrial myxoma; dilated cardiomyopathy; heart failure.

Figure 1.

Transesophageal echocardiogram showing the huge oval-shaped and calcified left atrial mass (arrows) adherent to the (a) interatrial septum and (b) systolic jet of mitral valve insufficiency from annular dilatation. (c) Axial and (d) coronal computed tomography showing the giant and slightly calcified left atrial mass, with its pedicle attachment to the atrial roof in proximity to the right superior pulmonary vein orifice and widely adherent to the interatrial septum. RA indicates right atrium; IaS, interatrial septum; Ao, aorta; MV, mitral valve; p, pedicle.

Figure 2.

(a) Operative view of the atrial tumor almost completely occupying the left atrium. (b) Surgical specimen of the mass. (c) At microscopic examination, polygonal cells surrounded by a highly myxoid stroma are observed. (d) Apical 4-chamber transthoracic echocardiogram at 1 year follow-up showing no evidence of recurrent myxoma in the left atrium and persistent significant left ventricular dilatation. LA indicates left atrium; LV, left ventricle.