Cardiac myxoma associated with coronary artery disease is a rare pathology in an elderly patient. Herein wepresent an 81-year-old woman undergoing simultaneous surgical treatment for left atrial myxoma combinedwith coronary artery disease. The postoperative course of the patient was uneventful. The initial removal ofmass should be performed to prevent systemic embolization of tumor fragment

Donbaloğlu, Mehmet Okan

Gürkan, Selami

Yümün, Gündüz

The European Research Journal

English

Namik Kemal University Institutional Repository

The European Research Journalhttp://www.eurj.orgCaseReporte-ISSN: 2149-3189 DOI: 10.18621/eurj.345590Left atrial myxoma combined with coronary artery diseasein an elderly patientGündüz Yümün, Selami Gürkan, Okan DonbaloğluDepartment of Cardiovascular Surgery, Namık Kemal University School of Medicine, Tekirdağ, TurkeyABSTRACTCardiac myxoma associated with coronary artery disease is a rare pathology in an elderly patient. Herein wepresent an 81-year-old woman undergoing simultaneous surgical treatment for left atrial myxoma combinedwith coronary artery disease. The postoperative course of the patient was uneventful. The initial removal ofmass should be performed to prevent systemic embolization of tumor fragments. Eur Res J 2018;4(2):129-131Keywords: Left atrial mass, coronary artery disease, elderlyAddress for correspondence:Gündüz Yümün, MD., Associate Professor, Namık Kemal University School of Medicine, Department of Cardiovascular Surgery, Tekirdağ, Turkey. E-mail: gunduzyumun@gmail.comReceived: October 23, 2017; Accepted: November 25, 2017; Published Online: December 1, 2017 Copyright © 2018 by The Association of Health Research & Strategy129Introduction      Atrial myxomas are accounting for nearly half ofprimary cardiac tumors in adults [1]. Approximately75-90% of cardiac myxomas are located in the leftatrium, mainly adhered to the atrial septum near thefossa ovalis [2, 3]. In most cases they encountered infemale patients with 40-60 years old [1]. The size ofthe myxoma is directly proportional to the severity ofthe patient's symptoms [4]. Coexistence of coronaryartery disease and myxoma is a rare condition and, itis reported in a limited number of case reports [5-8].We describe a rare case with simultaneous left atrialmyxoma and coronary artery disease in an elderlywoman with shortness of breath and chest pain.Case Presentation      An 81-year-old woman admitted to hospital withshortness of breath and chest pain. Upon physicalexamination, the patient had a heart rate of 78beats/min, and a regular blood pressure of 170/70mmHg. In the clinical history, she had undergonecoronary angiography 3 years ago and coronary arterydisease had been detected. There was no previousechocardiography report.       The systemic examination of the patient wasnormal. The electrocardiogram was also normal.Echocardiographic evaluation identified leftventricular apical akinesis with an ejection fraction of45% and showed a left atrial mass 38×32 mm in sizesattached to the interatrial septum of the left atriumwithout obstruction.       Coronary angiography showed plaques with non-critical stenosis in the left circumflex coronary artery,an ostial stenosis of 90% of the right coronary artery,but 90% stenosis at the proximal portion of the leftanterior descending coronary artery (Figure 1).       After general anesthesia surgery was performedvia a median sternotomy. The aorta, and superior andinferior venae cava were cannulated, andcardiopulmonary bypass with moderate hypothermia(28-30°C) was instituted. To minimize the risk ofdeveloping perioperative embolism the heart wasgently handled during the operation. First the left atrialmass excised via interatrial groove approach (Figure2). Excision of the tumor was performed with itspedicle originated from the left side of the atria. Weperformed coronary artery bypass grafting after theclosure of the left atriotomy. For coronaryrevascularization of left descending coronary arterythe internal thoracic artery was used and a saphenousvein graft anastomosed to aorto-right coronaryposition. The postoperative course was uneventfulwithout any complication.Discussion      We have presented a rare case of concomitantatherosclerotic coronary artery disease and left atrialmyxoma. Moreover, this patient was the oldest patient130Eur Res J 2018;4(2):129-131 Atrial myxoma combined with coronary artery diseaseFigure 1. Coronary angiography shows demonstrating severe stenosis in the left anterior descending coronary artery (A) and theright coronary artery (B). Figure 2. Appearance of the atrial mass during surgical excision (A). Macroscopic view of the surgically removed myxoma (B).). with coronary artery disease associated myxomaaccording to literature review. Atrial myxomas are themost common primary heart tumors [2, 3]. However,the incidence of atrial myxomas ranges between 0.5and 1 per million of population/year and mean age ofpresentation has been reported between 40 to 60 years[1].       Left atrial myxoma may or may not producecharacteristic findings on physical examination. Themyxoma symptoms depend on mitral valveobstruction or distal organ embolization [4].Embolization is generally seen in central nervoussystem. But other organs such as the liver, spleen,kidney, retina, coronary vessels, and distal arterial treecan be affected [4]. Chest pain and dyspnea were themajor symptoms of the patient. Clinical findings werethought to be the result of partial cardiac obstructionin addition to coronary artery disease. In case of acutecoronary syndromes and left heart myxoma, coronaryembolization should always be considered [5]. Theincidence of coronary embolization of myxomas is0.06%. There was no evidence of major distalembolism in our patient. She had angina and shortnessof breath at the same time. So we decided to operationbecause of clinical deterioration.       The prevalence of coronary atherosclerotic diseasein patients with myxoma ranges between 20.3% and36.6% [6-9]. In this report the patient had coronaryartery disease according to coronary angiography 3years ago. But myxoma not reported in previousechocardiography note. Conclusions      Coronary angiography is required in elderlypatients who will undergo other cardiac operationsbecause of the risk of synchronous coronary arterydisease. Similarly, echocardiography is also requiredin patients with coronary artery disease, because of therisk of synchronous cardiac lesion, as seen in our case.Informed consent      Written informed consent was obtained from thepatient for the publication of this case report. Conflict of interest       The authors declared that there are no potentialconflicts of interest with respect to the research,authorship, and/or publication of this article. References[1] Bhan A, Mehrotra R, Choudhary SK, Sharma R, Prabhakar D, AiranB, et al. Surgical experience with intracardiac myxomas: long-termfollow-up. Ann Thorac Surg 1998;66:810-3. [2] Moyssakis I, Anastasiadis G, Papadopoulos D, Margos P, Votteas V.Second recurrence of cardiac myxoma in a young patien: a case report.Ann Thorac Surg 2005;101:501-2. [3] Toktaş F, Yavuz Ş, Özsin KK, Sanrı US, Türk T, Göncü MT. Cardiacmyxomas: an analysis of 39 patients. Eur Res J 2017;3:227-33. [4] Nurözler F, Tandoğan A, Yamak B. [Huge left atrial myxoma withminimal symptoms: case report]. Turk Gogus Kalp Dama 2003;11:52-3. [Article in Turkish] [5] Fang BR, Chang CP, Cheng CW, Yang NI, Shieh MC, Lee N. Totaldetachment of cardiac myxoma causing saddle embolization andmimicking aortic dissection. Jpn Heart J 2004;45:359-63. [6] Kocaturk H, Karaman A, Bayram E, Çolak MC, Yurtman V. Leftatrial myxoma and concomitant atherosclerotic coronary artery disease.Eurasian J Med 2009;41:202-4. [7] Erdil N, Ates S, Cetin L, Demirkilic U, Sener E, Tatar H. Frequencyof left atrial myxoma with concomitant coronary artery disease. SurgToday 2003;33:328-31. [8] Yavuz S, Toktas F, Eris C, Ata Y, Turk T, Goncu T. Left atrial massin a patient with previous coronary artery bypass grafting. Journal-CVS2014;2:7-9. [9] Gismondi RA, Kaufman R, Correa GA, Nascimento C, Weitzel LH,Reis JO, et al. [Left atrial myxoma associated with obstructive coronaryartery disease]. Arq Bras Cardiol 2007;88:e1-3. [Article in Portuguese] 131Eur Res J 2018;4(2):129-131 Yumun et al

Left atrial myxoma combined with coronary artery disease in an elderly patient

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Left atrial myxoma combined with coronary artery disease in an elderly patient

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