Introduction

Cardiac myxoma is a benign cardiac tumor that constitutes approximately 80% of the all cardiac tumors. Cardiac myxomas can devalope in any cavities of heart but 90% of them are located in left atrium and they are originated from fossa ovalis1 .They are generally seen in women aged 50-60 years2 . It has different clinic presentations according to its placement into heart3. While approximately 50% of patients with myxoma have clinial symptoms due to peripheral embolism or intracardiac obtruction, 10% of patients with myxoma have no symptoms4. In this case, we planned to present an old female patient with lef atrial mixoma that was unusual originated from pulmonary vein

CASE REPORT

An 82-years old female patient was consulted to cardiology department by the orthopedics before the knee operation. The patient had no cardiac story and medical treatment in her past. She had no diabetes mellitus or hipertension in spite of his advanced age. Her blood pressure was 100/70 mmhg, her heart beat was 106/min. Her blood test was normal. There was sinus tachycardia in her electrocardiogram. She had 1-2/6 systolic murmur in apical region so echocardiography was planned. In echocardiographic 4- chambers imaging, it was seen a fragmented and hyperechogenic mass (28x55 mm) originating from pumonary vein. The mass was stretched towards the left atrium base and restricted the internal flow of the ventricle. After transesophageal echocardiography, the mass was evaluated as myxoma and it was observed that it had developed in pumonary vein. Cardiac angiographic CT and operation were recommended to her but she refused.

Figure 1 Image of atrial myxoma in apical 4-space view inechocardiography; fragmented appearance of myxoma

DISCUSSION

Myxoma is a primer benign cardiac tumor that is seen as 0.3% in population4. It can cause symptoms due to its location, the degree of obstruction and its interference with valves or circulation. It usally presents with syncope, dispnea and chest pain in patients5. The embolisation of tumor to systemic or pulmoner circulation is seen as 30%-40% in patients6. Myxomas can be classified according to their smooth and irregular surface according to microscopic appearances. While solid type can cause vasoforming structures, papiller form is related to embolisms7 .

The cardiac myxoma is identified by echocrdiography, cardiac CT or MRI imagings. When it was diagnosed, it should be resected because of embolisation, cardiovascular complications and sudden cardiac death8. The outcomes of surgery are good and the mortality rate of patients during operation is under 5%9. But the surgery can cause development of arrhythmias and atrioventircular conduction defects in patients after surgery10. The recurrence is rarely after surgery exclude family story 9.

In this case, the patients was asymtomatic during long years although she had large sizes mxyoma. The mxyoma was detected incidentally in echocardiogram. We can explain it in two ways. One of them was slow growth of mixoma in years. The second way is that it did not cause mitral valve obstruction. But we thougt that the patient had hipotansion due to ventricular internal flow restriction although she had no symtoms. Perhaps she addicted her blood pressure levels in long time or the clinic presentation due to myxoma might not come out because of her physical limitation. The point that should not be missed was the possibility of a thrombus in pulmoary vein where myxoma originates.

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Conflicts of interest

There are no conflicts of interest.

References

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