Left Atrial Myxoma

Myxoma comprises 50% of all benign heart tumors in adults and it is more common in women than men. It usually occurs between the age of 30-60 years. Myxoma have a certain style of inheritance and can run in some families. Myxomas occur in any chamber of the heart but the most commonly originate in the left atrium. It usually arises from the wall between the left and right atrium (interatrial septum). When excised and examined by naked eye, they look like an egg (oval) and there surface is not smooth. They can reach up to 175 grams in size.

What are the symptoms and signs?

• General symptoms of fatigue, joint and muscle pains. Fever and red rash may be there also. Thickening of the nail beds (clubbing) can be seen.
• The tumor may obstruct blood flow in the heart causing sudden symptoms ( in left atrial myxoma, the tumor obstructs the opening of the mitral valve). Symptoms of left atrial myxoma tend to be similar to mitral valve stenosis. They produce shortness of breath, which can worsen and improve by certain positions.
• Fainting or syncopal episodes occur in some patients and are thought to result from complete temporary occlusion of the mitral orifice. Heart failure can occur.
• Sometimes a part of the tumor is detached from the mother tumor and travels in the blood stream (emobilization) causing symptoms in other body parts. In half of cases embolization occurs in the brain. Other sites of tumor embolization include abdominal organs, kidneys and coronary arteries.

Diagnosis

1. Examination: Your doctor can hear an abnormal sound which is described as tumor plop.
2. Chest radiograph: The findings on chest x-ray may include enlargement of the heart and some pulmonary congestion. Calcification within the tumor can be seen as white lines or spots.
3. Electrocardiographic findings: chamber enlargements and generalized enlargement of the heart.
4. Echocardiography: is the most useful test employed for the diagnosis and evaluation of myxoma. A transthoracic echocardiogram usually provides all the information for surgical resection, but transesophageal echocardiography provides the best information concerning tumor size, location, mobility, and attachment.
5. Computed tomography and magnetic resonance imaging: Neither CT nor MRI is needed for left atrial myxomas if an adequate echocardiogram is available because the information from these studies is not likely to change surgical strategy.

Treatment:

Surgical resection is the only effective therapeutic option for patients with left atrial myxoma and should not be delayed because death from obstruction to flow within the heart or embolization may occur in as many as 8% of patients awaiting operation. The operation is done through an incision in your breast bone. Heart and lung machine is used. The left atrium is opened and the tumor is exposed and excised. Sometimes another incision in the right atrium is done to help removal of the tumor. The defect in the atrial septum after excision of the tumor is repaired by a piece of pericardium (the membrane covering the heart).

Minimally invasive approaches can also be used for surgical removal.