Abstract
Atrial myxomas are the most common primary cardiac tumors. They are highly vascular with evidence of neovascularization and a characteristic“tumor blush” in approximately half of the cases. Although the visualization of feeding vessels has several clinical and therapeutic implications, there is still no consensus on the indication of preoperative coronary angiography to assess tumor vascularity except in patients with angina or those older than 40 years to rule out coronary artery disease. Herein, I present a case of an incidentally discovered right atrial mass receiving vascular supply from the right coronary artery. The mass was successfully excised and the diagnosis of cardiac myxoma was confirmed via histopathology. A review of the value of coronary angiography in detecting myxoma neovascularization is provided, which suggests that it can offer additional valuable information that can alter the surgical approach and therefore may be considered prior to myxoma resection.
Zusammenfassung
Vorhofmyxome sind die häufigsten primären Herztumoren. Sie sind hoch vaskularisiert mit Nachweis einer Neovaskularisierung und einer typischen Kontrastmittelverstärkung des Tumors („tumor blush“) in annähernd der Hälfte der Fälle. Zwar ist die Darstellung der versorgenden Gefäße unter verschiedenen klinischen und therapeutischen Aspekten von Bedeutung, aber es besteht bisher kein Konsens über die Indikation zu einer präoperativen Koronarangiographie, um die Tumorvaskularisierung zu untersuchen – außer bei Patienten mit Angina pectoris oder bei über 40-Jährigen zum Ausschluss einer koronaren Herzkrankheit. Hier wird der Fall eines zufällig entdeckten Tumors im rechten Vorhof mit Gefäßversorgung aus der rechten Koronararterie vorgestellt. Der Tumor wurde erfolgreich exzidiert und histopathologisch die Diagnose eines kardialen Myxoms bestätigt. Es wird eine Übersicht zur Bedeutung der Koronarangiographie bei der Untersuchung der Myxomneovaskularisierung gegeben – mit dem Fazit, dass diese Untersuchung wertvolle Zusatzinformationen, die eine Änderung der chirurgischen Herangehensweise bewirken können, liefern kann und daher möglicherweise vor einer Myxomresektion erwogen werden sollte.
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Conflict of interest. H.R. Omar states that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.
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Additional material onlineThis article includes three additional videos. You will find this supplemental at dx.doi.org/10.1007/s00059-013-3930-z.
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59_2013_3930_MO1_ESM.mp4
Video 1. Transthoracic echocardiogram showing an echogenic mass measuring 25 x 20 mm, arising from the inferior portion of the inter-atrial septum close to the origin of the septal leaflet of the tricuspid valve and prolapses through the tricuspid valve during diastole (MP4 21,1MB)
59_2013_3930_MO2_ESM.mp4
Video 2. Transesophageal echocardiogram showing the attachment of the mass to the inter-atrial septum but not the tricuspid leaflet (MP4 21,1MB)
59_2013_3930_MO3_ESM.mov
Video 3. Right coronary angiography showing the mass opacified with contrast dye and its vascular supply by neoformed vessels originating from the right coronary artery (MOV 1,1MB)
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Omar, H. The value of coronary angiography in the work-up of atrial myxomas. Herz 40, 442–446 (2015). https://doi.org/10.1007/s00059-013-3930-z
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DOI: https://doi.org/10.1007/s00059-013-3930-z