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Published on: February 26, 2013
30-year follow-up of an unoperated left atrial myxoma: a case report
Zeinelabdien Elsherif1,2,3, Naveed Mahmood2,3,4, Amjad M Ahmed1,2,3
1King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guard Health Affairs, PO Box 22490, Riyadh 11426, Saudi Arabia.
Insights
This study followed an unoperated left atrial myxoma for 30 years. The cardiac tumor naturally became smaller and more calcified over time, offering insights into cardiac myxoma progression.
Area of Science:
- Cardiology
- Oncology
Background:
- Cardiac myxomas are the most common primary cardiac tumors, typically benign.
- They often present with stroke, valve obstruction, or vague symptoms.
- Surgical resection is the standard treatment.
Purpose of the Study:
- To describe the natural history of an unoperated left atrial myxoma.
- To observe the long-term progression of a cardiac myxoma.
- To investigate the growth rate and changes in cardiac myxomas prior to surgical intervention.
Main Methods:
- A case report of a 56-year-old female with a left atrial mass.
- Diagnosis confirmed via transthoracic and transesophageal echocardiography.
- Long-term follow-up for nearly 30 years using cardiac magnetic resonance imaging.
Main Results:
- The left atrial mass, confirmed as myxoma, was initially recommended for surgical removal.
- The patient opted for conservative management and was monitored for three decades.
- Over 30 years, the myxoma significantly decreased in size and became more calcified.
Conclusions:
- Cardiac myxomas exhibit heterogeneous growth rates, with limited data on unoperated tumors.
- This case demonstrates that a left atrial myxoma can spontaneously regress and calcify over a long period.
- The natural progression of cardiac myxomas may involve size reduction and calcification without surgical intervention.
Background:
Cardiac myxomas are the most common benign primary cardiac tumours. The natural history of left cardiac myxomas is thought to be of slowly growing tumours. Cardiac myxomas are a heterogeneous group with a variable growth rate. They present usually with stroke, valve obstruction, or non-specific symptoms. Surgical resection is the effective treatment.
Case Summary:
This case report describes a 56-year-old hypertensive and dyslipidaemic female, when she was admitted in January 1990, complaining of loss of appetite, aches, pains, and palpitations. Her workup included a transthoracic echocardiography and transoesophageal echocardiography, which showed a left atrial mass attached to the inter-atrial septum, highly suggestive of left atrial myxoma. She was referred for surgical removal of the left atrial mass. However, she was reluctant to undergo surgery as she felt better. The patient was followed-up for almost 30 years with the left atrial mass confirmed as left atrial myxoma by cardiac magnetic resonance imaging. The left atrial mass became smaller in size and more calcified.
Discussion:
Cardiac myxomas are a group of heterogeneous tumours, thought to be slowly growing. The growth rate of cardiac myxomas prior to diagnosis is not well known, as the vast majority is treated with surgical resection immediately after diagnosis. Our case showed the natural progression of an unoperated smooth-surfaced left atrial myxoma followed-up for almost 30 years, which slowly became smaller and more calcified.
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