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Updated: Jul 4, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Surgical resection of left atrial myxoma presenting with acute multiple hemorrhagic cerebral infarctions: a case
Michael G Katz1, Vitaly Finkelshtein, Dominique Ben-Ami Raichman
1Department of Cardiothoracic Surgery, E. Wolfson Medical Center, Holon, Israel.
Insights
Left atrial myxoma can cause brain bleeds. This case study shows successful surgical removal of a left atrial myxoma in a patient with acute hemorrhagic brain infarction.
Area of Science:
- Neurology
- Cardiology
- Oncology
Background:
- Left atrial myxoma embolization commonly causes brain ischemia.
- The association between intracerebral hemorrhage and cardiac myxoma is less understood.
- Metastatic myxoma cells may damage cerebral vessels, leading to aneurysms and bleeding.
Observation:
- A patient presented with acute hemorrhagic brain infarction.
- Echocardiography confirmed the presence of a left atrial myxoma.
- The patient underwent successful surgical resection of the myxoma during the acute phase.
Findings:
- The study highlights a rare case of intracerebral hemorrhage secondary to left atrial myxoma.
- Successful surgical resection was achieved in the acute neurologic phase.
- This challenges the typical contraindication for immediate surgery after intracerebral hemorrhage.
Implications:
- Early surgical intervention for left atrial myxoma is crucial, even with acute intracranial bleeding.
- This case provides evidence for managing neurologic complications of cardiac myxoma.
- Further research is needed to refine management strategies for these complex cases.
Abstract:
Brain ischemia resulting from left atrial myxoma embolization has been well documented. In contrast, the link between the development of intracerebral hemorrhage and myxoma in these patients has little coverage in the literature. The main theory describing this relationship stems from the fact that cardiac myxoma cells metastasize to the brain's vessels, causing destruction of the arterial wall with subsequent formation of fusiform aneurysm and further intracranial bleeding. It is assumed that when a diagnosis of left atrial myxoma with neurologic manifestations is made, surgical resection should be performed without delay to prevent repeated tumor embolization; however, systemic anticoagulation treatment during cardiac surgery with cardiopulmonary bypass is not recommended immediately after intracerebral hemorrhage occurs because of the possibility of extending the infarct's size. We describe a patient with acute hemorrhagic brain infarction and an echocardiographically demonstrated left atrial myxoma that was surgically resected successfully in the acute phase after the onset of the neurologic symptoms.
