Giant Left Atrial Myxoma Presenting with Mitral Valve Obstruction

A 71-year-old woman was evaluated in the emergency department for fatigue, progressive dyspnea on exertion, and a nonproductive cough. She had a medical history of psoriasis, hypercholesterolemia, and a small hiatal hernia. The results of electrocardiographic and chest radiographic studies were normal. Two-dimensional echocardiography and Doppler video showed a large echo-dense mass attached to the left side of the interatrial septum. The mass appeared to be an atrial myxoma measuring 7.3 × 3.0 cm with a circumference of 18.2 cm and an area of 20 cm². Figure 1 shows the parasternal long-axis view of the Doppler video echocardiogram in systole. In diastole, the mass obstructed the left ventricular inflow and protruded through the mitral valve into the left ventricle as shown in Figure 2. At surgical resection, the myxoma appeared to have a narrow base; it was centered in the fossa ovalis on the left atrial side of the septum. The mass was resected, including the septal attachment. A bovine pericardial patch was used to close the defect, which was approximately 2 × 3 cm.

Fig. 1

Fig. 2

The postoperative period was uneventful. Pathologic examination showed a gelatinous myxoma that weighed 43 g and measured 6.5 × 3.5 × 3.5 cm. The cut surface was partially necrotic and hemorrhagic; on 1 end was an attached portion of the resected atrial septal tissue (Fig. 3). At the patient's 6-month postoperative evaluation, she had fully recovered and was asymptomatic.

Fig. 3