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Giant Left Atrial Myxoma Causing Dynamic Mitral Inflow Obstruction: A Ball in Play
Harith Almimar1, Osmaan Chaudhri1, Khristoffer Bury-Hernandez1
1HCA Florida JFK Hospital, Atlantis, Florida, USA.
Insights
Giant atrial myxomas, rare but dangerous cardiac tumors, can cause severe obstruction. Early detection and surgical removal are crucial for reversing hemodynamic compromise and improving heart function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Oncology
Background:
- Atrial myxomas are the most common primary cardiac tumors.
- Larger myxomas (>5 cm) increase risks of obstruction and hemodynamic compromise.
- Giant atrial myxomas are exceptionally rare.
Background:
Atrial myxomas are the most common primary cardiac tumors. Larger tumors (>5 cm) are associated with increased risk of obstruction and hemodynamic compromise, while very large ("giant") myxomas are rare.
Case Summary:
A 34-year-old man with atrial fibrillation was found to have a large left atrial mass after presenting with tachyarrhythmia. Echocardiography demonstrated an ovoid mass prolapsing through the mitral valve, producing functional mitral stenosis (mean gradient 8 mm Hg), marked atrial dilation, and reduced ejection fraction (30%). Surgical resection revealed a near-spherical tumor measuring 8.2 × 5.5 × 5.5 cm attached to the interatrial septum. Left ventricular function improved to 45% after 7 days postop.
Discussion:
Giant atrial myxomas can cause severe hemodynamic compromise through mechanical obstruction, with tumor size and morphology playing key roles.
Take-Home Message:
Obstructive physiology from atrial myxomas can be reversible, highlighting the importance of early recognition and surgical intervention.
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