Education  |   July 2019
Giant Left Atrial Myxoma Obstructing Mitral Valve Bloodflow
Author Notes
  • From the Departments of Anesthesia and Perioperative Medicine (S.E.G., W.V.) and Cardiology and Noninvasive Procedures (A.M.), Clínica Universitaria Colombia, Bogota, Colombia.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Gutierrez: se.gutierrezvi@unisanitas.edu.co
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   July 2019
Giant Left Atrial Myxoma Obstructing Mitral Valve Bloodflow
Anesthesiology 7 2019, Vol.131, 151-152. doi:10.1097/ALN.0000000000002691
Anesthesiology 7 2019, Vol.131, 151-152. doi:10.1097/ALN.0000000000002691
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, http://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.