Little devil takes your breath away
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Neovascularisation of a large tumour in the left atrium.
Left atrial myxoma is the most common primary cardiac tumour . The clinical presentation is largely determined by the size, location and mobility of the tumour. Although cardiac myxomas are benign, the manifestations can be serious, i.e. embolisation, obstruction and arrhythmogenesis. Embolic manifestations may include stroke, myocardial infarction and/or visceral infarctions. Multimodality imaging is pivotal in diagnosing atrial myxomas. Preoperative coronary angiography may show the presence of vascularity of myxomas, mostly from the left circumflex artery . This neovascularisation favours the diagnosis of a cardiac myxoma rather than a thrombus, which is usually non-vascularised . Surgical resection should be performed as soon as possible after diagnosis, as the risk of embolisation is high. In cases with evidence of blood shunting, due to either spurting from the myxoma surface or fistula formation resulting in a steal phenomenon, these feeding vessels should be ligated during the surgery. Follow-up is mandatory for early detection of recurrence.
Conflict of interest
M.A.C. Koole, J.A. Winkelman, A. Kaya and M.A. Beijk declare that they have no competing interests.
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