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Review
. 2019 Feb 25;12(2):e225900.
doi: 10.1136/bcr-2018-225900.

How does knowledge of the blood supply to an intracardiac tumour help?

Prabha Nini Gupta  1 , Nishant Sagar  1 , Ritesh Ramachandran  1 , Velenurre Rajagopalan Rajeshekharan  1
Affiliations
Review

How does knowledge of the blood supply to an intracardiac tumour help?

Prabha Nini Gupta et al. BMJ Case Rep. .

Abstract

Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.

Keywords: cardiothoracic surgery; cardiovascular medicine; hemangioma; surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The m mode picture of the myxoma showing the ‘time gap’ phenomenon that shows it is a myxoma and not an thrombus attached to the mitral valve. The tumour prolapses a little later and then the valve opens, so the ‘time gap’ is seen.
Figure 2
Figure 2
A picture of the myxoma in the left atrium on echocardiogram.
Figure 3
Figure 3
A coronary angiogram of the patient showing the blood supply from the right coronary artery.
Figure 4
Figure 4
Another view of the mass showing tumour blush and vascularity and blood supply from the right coronary artery.
Figure 5
Figure 5
The left coronary artery and no evidence of tumour vascularity.
Figure 6
Figure 6
An operative picture of the mass in the left atrium.
Figure 7
Figure 7
The excised mass with a smooth surface, a myxoma.
Figure 8
Figure 8
The low power illustration of the myxoma.
Figure 9
Figure 9
The high power view of the myxoma showing a typical histological pattern.
See this image and copyright information in PMC

References

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