Correspondence

Angiographic Visualization of an Atrial Myxoma

N Engl J Med 2000; 342:294-295January 27, 2000

Article

To the Editor:

Myxoma is the most common type of primary cardiac tumor, and approximately 86 percent of myxomas develop in the left atrium.1 Right atrial myxomas are rare; patients usually present with dyspnea, fever, weight loss, right-sided heart failure, or pulmonary embolization.1,2 We describe a patient who had a large right atrial myxoma with an unusual presentation and a unique appearance on angiography.

A 45-year-old man was hospitalized because of a new atrial flutter. A transthoracic echocardiogram showed a right atrial mass. Transesophageal echocardiography subsequently confirmed the presence of a right atrial myxoma (Figure 1Figure 1Transesophageal Echocardiogram Showing a Right Atrial Myxoma in a 45-Year-Old Man.), which prolapsed from the right atrium into the right ventricle during diastole. Before surgery, coronary angiography was performed to rule out clinically significant coronary artery disease. On angiography, the myxoma was opacified with contrast dye (Figure 2Figure 2Coronary Angiogram Showing the Myxoma (Large Arrowheads) and Its Arterial Blood Supply (Small Arrowheads)., large arrowheads); it had a rich arterial blood supply (Figure 2, small arrowheads) from the right coronary artery. At surgery, the myxoma (7 by 6 by 4 cm) was excised from the right atrium. The patient underwent cardioversion intraoperatively, and normal sinus rhythm was restored. Six months after surgery, the patient was doing well, with no recurrent symptoms or atrial arrhythmias.

Coronary angiography can be useful in the diagnosis and evaluation of atrial myxomas by demonstrating a vascular blush in the tumor. Angiographic visualization of the vascular supply of a myxoma, in addition to the echocardiographic findings with respect to its size and site of attachment,3 provides valuable information.

Jaber I. Sawaya, M.D.
Habib A. Dakik, M.D.
American University of Beirut, Beirut, Lebanon

3 References

1. 1

   Salcedo EE, Cohen GI, White RD, Davison MB. Cardiac tumors: diagnosis and management. Curr Probl Cardiol 1992;17:73-137
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2. 2

   Harvey WP. Clinical aspects of cardiac tumors. Am J Cardiol 1968;21:328-343
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3. 3

   Smith ST, Hautamaki K, Lewis JW Jr, Serwin J, Alam M. Transthoracic and transesophageal echocardiography in the diagnosis and surgical management of right atrial myxoma. Chest 1991;100:575-576
   CrossRef | Web of Science | Medline