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We describe a comatose female patient after electroconvulsive therapy. Head imaging showed diffuse cerebral emboli. Transesophageal echocardiography showed left atrial myxoma which was resected soon thereafter. The article describes the presentation, complications and treatment of myxomas and discusses electroconvulsive therapy, its adverse events and the possible relation to myxoma embolization., Competing Interests: Declaration of competing interest We declare all authors had no conflict of interest. We did not receive any funding and the work was the authors own work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Myxomas account for approximately half of all primary cardiac neoplasms. Most occur in the left atrium and only rarely are attached to the mitral valve, with just over 30 such cases reported in the literature. These neoplasms can manifest with a combination of obstruction of blood flow, systemic embolization, and constitutional symptoms., Case Description: We present a case of a 32-year-old African American man presenting at an emergency department with symptoms of a transient ischemic attack. Transesophageal echocardiography identified a mass originating from the posterior leaflet of the mitral valve. The mass was surgically resected and histologically classified as a myxoma. He remained asymptomatic during the course of 5-year surveillance., Conclusions: Few similar cases have been described in the literature. Here we present a review of the diagnosis and surgical management of this rare presentation for mitral valve myxoma.

A 69-year-old woman presented with a 2-week history of chest pain and mitral and aortic valve replacement 15 and 5 years earlier. Transthoracic echocardiography revealed a well-seated monoleaflet mitral valve and a bileaflet aortic valve with normal function. Cardiac catheterization showed 3-vessel coronary artery disease and an abnormal cluster of new vessels derived from the left atrial circumflex and posterior ventricle branches. Two- and 3-dimensional transesophageal echocardiography identified a semi-mobile oval left atrial mass with multiple internal cystic spaces, attached to the fossa ovalis region in the interatrial septum. The mass was resected. The pathological diagnosis was atrial myxoma., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Transesophageal echocardiography (TEE) is an important diagnostic tool. It provides structural and functional assessment of cardiac structures which can improve the overall outcome of the patient. We present a case with right atrial myxoma in which TEE helped to find the attachment of the mass so that overall surgical plan was changed.

Background: Cardiac tumors are a rare cause of recurrent syncope which are detected on echocardiography, computed tomographic scan, and/or magnetic resonance imaging. We present echocardiographic, anatomic, and histopathologic images of a cardiac tumor arising from the junction of the right atrium and the inferior vena cava in a young lady., Methods: Transthoracic echocardiography, transesophageal echocardiography, postmortem examination (autopsy), and histopathology., Results: Transesophageal echocardiogram showed a 7×3-cm mobile multilobulated right atrial mass arising from the right atrial wall near the inferior vena cava. The patient was admitted to hospital to undergo cardiac surgery; however, unfortunately, she went in to cardiorespiratory arrest on the eve before surgery. Autopsy showed embolized mass obstructing the main pulmonary trunk, and pathology revealed an old organizing thrombus., Conclusions: Cardiac thrombi can mimic appearances of a myxoma on echocardiogram. Delay in thrombus removal surgery can result in increased mortality as seen in our case., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A 15 × 13 mm mobile ovoid mass attached via a 15 × 5 mm stalk to the interatrial septum in the left atrium was detected on transesophageal echocardiography and was diagnosed as a myxoma in a 70-year-old woman with chronic atrial fibrillation. She was prescribed anticoagulant therapy with warfarin before elective cardiac surgery and demonstrated no thromboembolic event during a 2.5-month period. Preoperative transesophageal echocardiography showed the disappearance of the intracardiac mass and the presence of a left atrial septal pouch, suggesting that the initial image was a thrombus originating from the left atrial septal pouch., (Copyright © 2013 Wiley Periodicals, Inc.)

Objective: To evaluate the role of intraoperative transesophageal echocardiography (TEE) during robotic atrial myxoma excision., Methods: Thirty-eight consecutive patients undergoing robotic atrial myxoma excision from September 2007 to August 2012 were enrolled in the study. During the procedure, TEE was performed to document the myxoma position, its attachment, and hemodynamic information before cardiopulmonary bypass (CPB). During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure., Results: The accuracy of TEE for the position or its attachment of the myxoma was 100%. All the cannulae in the SVC, IVC and AAO were located in correct position. In all patients, TEE confirmed successful excision., Conclusion: Intraoperative TEE is a valuable adjunct in patients undergoing robotic atrial myxoma excision.

Atrial myxomas often show contrast enhancement following administration of intravenous gadolinium, whereas thrombus appears as a hypointense structure, typically without any contrast enhancement. This case report presents a diagnostic challenge involving a recently developed left atrial mass in which echocardiography and cardiac MRI provided discordant results. While the morphological characteristics of the new left atrial lesion were suggestive of myxoma, the signal characteristics and behavior following intravenous gadolinium at MR, and, in particular, the rapid interval appearance of the lesion, prompted consideration for left atrial thrombus. Subsequent intra-operative and histopathologic evaluation proved the mass to be a left atrial myxoma.

Cardiac papillary fibroelastomas are the most common primary valvular tumors. Generally benign, they account only for about 10% of all primary cardiac neoplasms, can occur in normal or diseased hearts, and are associated strongly with open heart surgery and radiotherapy. They are, in most cases, incidental findings, but can be discovered after syncope. We report the case of an elderly female, who was referred for syncope and was found to have a large fibroelastoma at the mitral valve annulus, intermittently obstructing the left ventricular inflow tract, and mimicking the presentation of left atrial myxoma. This case illustrates another potential mechanism of syncope in patients with fibroelastomas., (Copyright © 2012 Wiley Periodicals, Inc.)

A 31-year-old female presented with right-sided stroke symptoms. She was found to have a left ventricular (LV) mass on transthoracic echocardiogram. Subsequent transesophageal echocardiogram (TEE) with concurrent three-dimensional (3D) imaging revealed a 2-cm mobile mass, suspicious for a myxoma, attached to the anteroseptal LV wall. Given the size and location of the mass seen on the 3D images, the cardiothoracic surgeons chose to avoid resection via aortotomy or ventriculotomy and instead performed video-assisted cardioscopic resection of the LV mass via left atriotomy. The mass was successfully removed, and pathology confirmed that it was a myxoma., (© 2012, Wiley Periodicals, Inc.)

Myxomas are the most common primary cardiac tumor, and neovascularization of cardiac myxoma has been shown in previous case reports. However, it is seldom reported that abnormal blood flow spurted from a neovascularized myxoma into the cardiac chamber. In this unusual case report, we present a left atrial myxoma in a 44-year-old woman with atypical angina. Transesophageal echocardiography (TEE) revealed several small blood streams spurting from the surface of massively vascularized myxoma into the left atrium. Coronary angiography showed a feeding artery which arose from the right coronary artery and supplied the left atrial myxoma, with no evidence of coronary artery stenosis. This case demonstrated that TTE might be helpful for confirming the neovascularization of myxoma in the left atrium and finding the abnormal blood flow that spurts from the neovascularized myxoma. We speculate that the abnormal blood flow spurting from the neovascularized myxoma into the left atrium may have caused a coronary steal phenomenon thus resulting in myocardial ischemia., (© 2012, Wiley Periodicals, Inc.)

Background and Aim of the Study: The mitral annulus (MA) has a complex dynamic geometry that is difficult to visualize in two dimensions; hence, novel real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) provides insights into its dynamic nature. The study aim was to investigate changes in MA geometry in normal subjects and to explore differences in patients with myxomatous mitral valve disease (MMVD), using 3D quantitation with RT-3D-TEE., Methods: Thirty-five participants (18 with MMVD, 17 normal subjects as controls) were enrolled into the study. The following geometric measurements were obtained at end-systole (ES) and end-diastole (ED): surface area, circumference, perimeter, height, commissure-to-commissure (C-C) diameter, anterior-to-posterior (A-P) diameter, and the ratio of A-P diameter to C-C diameter (circularization). To detect the effect of the severity of mitral regurgitation (MR) on MA dynamics, patients with MMVD were allocated to two subgroups with mild (n = 7) or moderate/severe (n = 11) MR., Results: Control subjects demonstrated a saddle-shaped, elliptical MA configuration with slightly larger ES parameters. The MA shape was changed during the cardiac cycle, being more circular at ES and flatter at ED (p < 0.05). In MMVD patients, the MA retained a saddle shape but became dilated and circular with larger ED parameters compared to controls (p < 0.05). The degree of MA geometric changes was more prominent in moderate/severe MR patients (p < 0.001), while mild MR patients displayed MA geometry and dynamics similar to those of controls., Conclusion: The MA geometry is altered in MMVD patients, with the extent of changes being determined by the severity of the MR. RT-3D-TEE provides high-quality images that permit a precise quantitative analysis of the 3D geometry of the MA.

In this study, a case of a right ventricular myxoma and a case of a right ventricular hemangioma are used to demonstrate the ability of live three-dimensional transesophageal echocardiography (3DTEE) to assess the site of tumor attachment. Because 3DTEE has the ability to visualize desired structures in multiple planes, we defined the attached portion of the tumors and measured the en face view dimensions. In addition, the improved ability of 3DTEE to evaluate tissue characteristics allowed differentiation of the heterogeneous myxoma and highly vascular hemangioma. On the contrary, because two-dimensional (2D) TEE only allows structures to be viewed in a 2D plane, the attachment site can be located but complete delineation and measurement of area is not possible. As surgical options become less invasive, accurate attachment site location and size will become more important to ensure complete excision., (© 2011, Wiley Periodicals, Inc.)

Myxoma is the most common benign cardiac neoplasm. A 66-year-old woman presented with a large left atrial myxoma, which was detected by a real-time three-dimensional echocardiography (RT3DE) and a real-time three-dimensional transoesophageal echocardiography (RT3D-TEE) approach. RT3DE and RT3D-TEE proved to be techniques that can provide additional contributions to the diagnostic investigation of structural heart diseases.

Background: Although transthoracic echocardiography and two-dimensional transesophageal echocardiography (TEE) identify cardiac myxomas with high sensitivity, anatomic and morphologic information is often incomplete. Real-time three-dimensional (3D) TEE is increasingly being used in general clinical practice. However, the use of real-time 3D TEE for the assessment of atrial myxomas has not been described., Methods: This case series of 10 patients with left atrial myxomas undergoing two-dimensional and real-time 3D TEE., Results: Correlative pathologic findings demonstrate that 3D imaging accurately identifies these tumors and provides detailed morphologic description of the tumors, which may have clinical importance., Conclusions: Because the 3D TEE is real time and can be performed preoperatively in the operating room, the surgeon may gain a better understanding of the nature and location of the tumor., (Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Myxomas are rare tumours but are the most common benign tumours of the heart. They can arise from any heart chamber. However, they arise more frequently from the left atrium. They have rarely been described as originating from two different chambers. Their clinical presentation is varied and may mimic arterial embolism or symptoms of cardiac, infectious, malignant and immune diseases, therefore making their diagnosis challenging. We report a case of a young female patient with left atrial and right ventricular myxomas who initially presented with neurological symptoms (visual and speech disturbances). Transoesophageal echocardiography has become an invaluable tool to diagnose myxomas and plan the surgical approach.

We report a rare case of association between mitral valve fibroelastoma and myxomatous disease in a patient with long history of asymptomatic myxomatous disease and progressive severe mitral regurgitation. The tumor was an intraoperative transesophageal echocardiographic finding and was confirmed during surgery. The differential diagnosis of the echocardiographic image was infective endocarditis., (Copyright © 2010 Wiley Periodicals, Inc.)

We report a unilateral right atrial familial myxoma with a multicentric nature discovered during cardiac surgery. After the patient was weaned off cardiopulmonary bypass, an inferior vena cava myxoma was discovered with intra-operative trans-oesophageal echocardiogram (TOE) which had been missed preoperatively and during surgery.

We present the case of a rare echocardiographic image of a giant cavitated myxoma and the pathologic findings of the cystic mass. The new echocardiographic equipment not only has improved the sensitivity for diagnosis of different pathologies but also has redefined its visual and morphologic characteristics. Although most myxomas are solid masses and some cystic myxomas have been reported, the presence of multiple cavities on echocardiographic exam has exceptionally been described. While cystic changes have been described at autopsy in 14% of cardiac myxomas, its identification with echocardiography is rare. Nowadays, the new echocardiographic equipment has improved the quality and the accuracy to detect and describe intracardiac masses, showing myxomas with cystic cavities in vivo that in the past was a pathologic finding.

Background and Study Aims: Endoscopic ultrasound and fine-needle aspiration of paramural lesions are established diagnostic techniques in gastroenterology and are now also used for therapeutic purposes. The proximity of the heart to the esophagus and the utility of the diagnostic technique of transesophageal echography prompted us to explore the possibilities of approaching the heart through the esophagus., Methods: In acute experiments (n = 2) and survival experiments (n = 6) on anesthetized pigs, the anatomical landmarks were first identified and studied, before introduction of the needle through the posterior cardiac wall into the left atrium, and then beyond, as far as the aortic valve. The smallest structure targeted was the coronary artery. The animals in the survival group were monitored clinically over a 2-week period and also underwent endoscopic and cardiologic re-examinations prior to autopsy. Three patients were also investigated using the technique., Results: No visible damage was observed in the heart in the two animals which were sacrificed immediately or in the six surviving pigs (except for one small hematoma). The needle could be introduced repeatedly into the left atrium, followed by the injection of saline. Reaching the aortic valve was more difficult because of the moving target, but ablation therapy was technically possible. The coronary artery was successfully punctured in three of the animals (all three weighed 40 kg or more); in smaller animals, the needle overshot the lumen of these minute arteries. Of the three patients investigated, pericardial fluid was successfully aspirated in two patients and a left atrial mass was punctured in the third patient (excluding neoplasia, the final diagnosis being thrombus)., Conclusion: These animal studies and clinical cases suggest that transesophageal intracardiac procedures could become feasible and that further exploration by gastroenterologists and cardiologists may be justified.

Background: An unusual sequence of post operative events heralded by hemodynamic deterioration followed by dyspnea and rapidly progressive dilatation of superficial neck and facial veins, resembling a superior vena cava syndrome, two days post surgical resection of filamentous aortic valve masses, closure of a patent foramen ovale, and performance of a modified Maze procedure for atrial fibrillation in a patient that presented with transient neurologic findings is presented., Case Presentation: Although both clinical findings and hemodynamic derangements completely resolved following tricuspid valve repair aimed to correct the new onset severe tricuspid regurgitation noted post operatively; a clear mechanism was not readily obvious and diagnostic testing data somewhat conflictive. We present a careful retrospective examination of all clinical data and review possible clinical entities that could have been implicated in this particular case and recognize that transesophageal echocardiographic findings were most useful in identifying the best course of action., Conclusion: After reviewing all clinical data and despite the inconclusive nature of test results; the retrospective examination of transesophageal echocardiographic findings proved to be most useful in identifying the best course of action. We postulate that in our case, resolution of the suspected pulmonary embolism with anticoagulation and reestablishment of a normal right ventricular geometry with tricuspid valve repair worked in unison in restoring normal hemodynamics and resolving both dyspnea and venous dilatation.

A young man underwent Focused Assessment with Sonography in Trauma (FAST) scan for blunt abdominal trauma. An incidental finding on the pericardial view was the presence of a tumor in the right ventricle. Detailed cardiac imaging and subsequent excision revealed the presence of a myxoma. The patient had no obvious cardiac symptoms, but the awareness and experience of the examiner during the FAST examination detected this rare heart tumor at a latent stage, preventing serious, irreversible complications. This case demonstrates the potential importance of looking above the diaphragm during routine abdominal sonography, especially in patients who are critically ill.