J INVASIVE CARDIOL 2018;30(11):E130.
Key words: cardiac imaging, transesophageal echocardiogram, transthoracic echocardiogram
We present a case of a 73-year-old woman with exertional chest pain and mild dyspnea for several months duration. The patient’s medical history included a metabolic syndrome and paroxysmal atrial fibrillation. On examination, she had a normal cardiac auscultation and there were no signs of heart failure.
Transthoracic echocardiogram (TTE) showed a large pedunculated left atrial mass at the interatrial septum. Left ventricular function was normal and there was mild mitral valve regurgitation. A smaller atrial mass was seen on a previous TTE 2 years prior. Subsequently, transesophageal echocardiography confirmed the left atrial mass (2.3 x 2.2 cm). Diagnostic and preoperative coronary angiography showed no significant stenosis in the coronary arteries. Interestingly, during coronarography, we saw a strongly neovascularized left atrial mass that was supplied by two main coronary vessels.
Multiple branches arose from the right coronary artery (RCA) (Figure 1; Video 1), and another branch originated in the left circumflex (LCX) (Figure 2; Video 2). The patient underwent a complete surgical excision of the left atrial mass and histopathologic analysis confirmed the diagnosis of an atrial myxoma. After surgery, there was a resolution of chest pain and dyspnea.
In this case, preoperative coronary angiography showed neovascularization originating from the RCA and LCX. Vascular supply in left atrial myxomas usually originates from the LCX and sometimes from the RCA, but vascular supply from both the right and left coronary arteries is rarely seen.
Watch the Accompanying Video Series here.
From the Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript accepted June 9, 2018.
Address for correspondence: Pascal Frederiks, MD, Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium. Email: firstname.lastname@example.org