The elusive cause of syncope: Left atrial myxoma with mitral valve obstruction

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Syncope is a common clinical presentation requiring thorough evaluation to identify underlying causes.
• Cardiac tumors, though rare, can present with syncope due to outflow tract obstruction or embolic events.
• Atrial myxomas are the most common primary cardiac tumors and can lead to significant hemodynamic compromise.

Observation:

• A 58-year-old woman presented with recurrent syncope.
• Initial investigations for pulmonary embolism were inconclusive, leading to further cardiac assessment.
• Transthoracic echocardiography revealed a large mass in the left atrium obstructing mitral valve inflow.

Findings:

• The left atrial mass was diagnosed as a neovascularized myxoma.
• The myxoma caused significant obstruction of the mitral valve, explaining the syncopal episodes.
• Coronary angiography was performed to assess vascular supply and rule out other cardiac pathologies.

Implications:

• This case highlights the importance of considering cardiac myxoma in the differential diagnosis of unexplained syncope.
• Transthoracic echocardiography and coronary angiography are essential tools for diagnosing cardiac masses.
• Successful surgical resection of the myxoma resolved the patient's symptoms, demonstrating the efficacy of interventional cardiology in managing such cases.