Cardiac myxoma is the most common cardiac tumor, but overall it is uncommon, representing approximately 0.2% of all neoplasms. In this example (images 1 and 2), the mass (yellow arrow) in the left atrium (54 × 26 mm) is typically polypoid with a rough core, irregular borders, and different echodensities. The mass is attached to the interatrial septum (black arrow, image 2) prolapsing toward the mitral valve (red arrow, image 1).
The majority of myxomas present with systemic emboli, fever and/or weight loss, or intracardiac obstruction to blood flow.1 Echocardiography detects myxoma with high (95 to 99%) sensitivity,2 and three-dimensional reconstruction allows detailed assessment of the mass, mitral valve compromise and left atrial morphology, as well ruling out alternative diagnoses (e.g., ventricular failure or valve dysfunction). Potential complications include partial obstruction of the mitral valve (present in this case, see Supplemental Digital Content, https://links.lww.com/ALN/B918) resulting in pulmonary vein congestion and pulmonary edema, elevated pulmonary artery pressure, and reduced cardiac output. Atrial dysrhythmia is also a considerable risk.
The treatment is surgical excision and key aims of anesthesia care include constant monitoring of systemic blood pressure, adequate IV fluids, and judicious use of vasoactive medications to prevent a fall in systemic vascular resistance.3 It is recommended to titrate the dose of propofol and fentanyl to obtain a proper anesthetic plane prior to endotracheal intubation, given the increased risk of mitral valve obstruction, use norepinephrine infusion 0.05 to 1 mcg · kg-1 · min-1 to maintain adequate myocardial perfusion and milrinone 0.3 to 0.5 mcg · kg-1 · min-1 if the patient has ventricular dysfunction.
Finally, a careful search for residual lesions using perioperative transesophageal echocardiography should be carried out after excision, in order to minimize the potential for recurrence.
Competing Interests
The authors declare no competing interests.
