Left Atrial Myxoma

by Carla Marotta, MD; Davide Ermacora, MD; Denisa Muraru, MD, PhD; Umberto Cucchini, MD, PhD
Department of cardiac, thoracic and vascular sciences, University of Padua, School of Medicine, Padua, Italy

Clinical Case

  • Female, 66 yrs old.
  • Admitted for retrosternal pain associated with palpitations.
  • Complained of fever, nausea, dyspepsia and weight loss in the past months, and occasional episodes of palpitations.
  • ECG: sinus rhythm, 85 bpm, left atrial enlargement, left ventricular hypertrophy.

Two-dimensional echocardiography from parasternal long axis, showing a voluminous, lobulated left atrial mass prolapsing in diastole through mitral valve orifice

Spectral CW Doppler across LV inflow, showing an increased diastolic gradient due to the obstruction caused by the atrial mass

Spectral CW Doppler across tricuspid valve, showing increased systolic pulmonary pressures.

Three-dimensional echocardiography from apical 4-chamber view, showing the adherence of the mass to the interatrial septum, characteristic of myxoma

Three-dimensional echocardiography from apical 4-chamber view, showing the adherence of the mass to the interatrial septum, characteristic of myxoma

LV: left ventricle; RV: right ventricle

Three-dimensional transversal cut plane of mitral valve visualized from left ventricular perspective, showing a large prolapsing mass in diastole, filling almost completely the mitral orifice area.

Transthoracic three-dimensional “surgical view”, confirming the characteristic insertion of the myxoma on the interatrial septum

LA: left atrium; RA: right atrium; IAS, interatrial septum; dotted line: insertion of the myxoma on interatrial septum.

Key Messages

2D/Doppler echocardiography enabled:

  • Identification and characterization of intracardiac mass (location, size, mobility etc)
  • Evaluation of attachment site in the interatrial septal region, suggestive of myxoma
  • Assessment of hemodynamic impact

3D echocardiography allowed:

  • More detailed anatomic description of the myxoma (particularly regarding shape, site of attachment, spatial relationship with neighbouring structures etc)
  • Dynamic analysis of left ventricular inflow obstruction in real time
  • “Surgical view” (i.e. atrial view), for more confident diagnosis of the attachment limited to the interatrial septum, and an optimized planning of surgical intervention

References

  • Plana JC. Three dimensional echocardiography to assess intra-cardiac masses. in Badano LP, Lang RM, Zamorano JL. Textbook of Real-Time Three Dimensional Echocardiography. Springer-Verlag London Limited 2011.
  • Butz T, Scholtz W, Korfer J et al. Prolapsing left atrial myxoma: preoperative diagnosis using a multimodal imaging approach with magnetic resonance imaging and real-time three-dimensional echocardiography. Eur J Echocardiogr 2008;9:430-2