Silent but Obstructive: A Left Atrial Myxoma Incidentally Identified During Cardiac Decompensation

Area of Science:

• Cardiology
• Cardiac Surgery
• Oncology

Background:

• Cardiac myxomas are rare, benign tumors, typically found in the left atrium.
• Despite benign histology, they can cause severe clinical issues like obstruction, embolism, and systemic symptoms.
• Myxoma presentation can mimic valvular heart disease or heart failure, delaying diagnosis.

Observation:

• A 72-year-old woman with hypertension and diabetes presented with rapidly progressing dyspnea (NYHA class III).
• Clinical findings included pulmonary congestion and hypertension.
• Transthoracic echocardiography revealed a large, mobile left atrial mass prolapsing into the mitral valve, causing significant obstruction and elevated pulmonary artery pressure.

Findings:

• Surgical excision of the left atrial myxoma was successful.
• Histopathology confirmed a benign myxoma with no malignancy.
• The patient experienced complete symptom resolution post-surgery.

Implications:

• This case underscores the obstructive potential of left atrial myxomas, mimicking mitral stenosis and leading to pulmonary hypertension.
• Echocardiography is vital for diagnosing cardiac tumors, surgical planning, and assessing risks like embolization.
• Clinicians must consider cardiac tumors in elderly patients with unexplained dyspnea and preserved ejection fraction; prompt surgical intervention is key.