Interv Akut Kardiol. 2005;4(4):236-241

CORONARY ANGIOGRAPHY AFTER MYOCARDIAL INFARCTION LED TO DIAGNOSIS OF LEFT ATRIAL MYXOMA.

Bihdan Lukáč¹, Pavol Chňupa²

¹ Interní oddělení Nemocnice Český Krumlov

² Oddelenie neinvazívnej kardiológie, Slovenský ústav srdcových a cievnych chorôb, Bratislava

Introduction: Myxomas are the most frequent cardiac tumours. The variable clinical picture includes symptoms of obstruction, embolisations and nonspecific constitutional signs. Rarely, the first manifestation may also be acute myocardial infarction, as we describe in this case report. Myxomas can create neovascularisations, visible by coronary angiography. Transesophageal echocardiography (TEE) is the diagnostic procedure of choice. Therapy is surgical.

Case report: Coronary angiography after myocardial infarction very rarely arouses suspicion of cardiac myxoma. A 57-year-old female patient after first anterior myocardial infarction was evaluated by coronary angiography. No serious stenoses or occlusions were found. An accidental finding was abnormal vascularisation from two branches of the right coronary artery (RCA) which led to the suspicion of tumour in the atria. First transthoracic echocardiography was negative and subsequent echocardiography yielded a doubtful result. TEE revealed left atrial myxoma. After successful surgical removal diagnosis of true myxoma was verified. Four years later, the patient underwent myocardial reinfarction. Coronary angiography revealed no serious coronary stenosis over 50 %. No abnormal vascularisations were seen. Transesophageal echocardiography ruled out recurrence of cardiac myxoma.

Conclusion: Abnormal coronary vascularisations are visible on coronary angiography in about 50 % of patients with cardiac myxoma. Subsequent transesophageal echocardiography leads to diagnosis and to curative surgical treatment.

Keywords: Key words: coronary angiography, cardiac myxoma, atrial myxoma, neovascularisation, pathologic tumor vascularisation, cardiac tumors, transesophageal echocardiography.

Published: January 1, 2006  Show citation