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Successful surgical resection of infected left atrial myxoma in a case complicated with disseminated intravascular coagulation and multiple cerebral infarctions: case report.

Yoshioka D, Takahashi T, Ishizaka T, Higuchi T - J Cardiothorac Surg (2011)

Bottom Line: Cardiac myxoma is the most common primary cardiac tumour, but infected cardiac myxoma is relatively rare.Until date, only one successful surgical treatment for a case complicated by DIC and cerebral infarctions has been reported, and our report describes second such case of successful resection.Even though this report is limited to a case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular surgery, Osaka National Hospital, 2-14 Hoenzaka, Chuo-ku, Osaka city, Osaka, 540-0006, Japan.

ABSTRACT
Cardiac myxoma is the most common primary cardiac tumour, but infected cardiac myxoma is relatively rare. Infected cardiac myxoma is very fragile, and has a potential to lead to catastrophic disorder with systemic bacteremia, systemic mycotic embolism, and disseminated intravascular coagulation (DIC).We present here the successful surgical treatment of a case of infected left atrial myxoma with septic shock, DIC and cerebral infarction without hemorrahage. Collective review of 58 reported cases with infected cardiac myxoma revealed that surgical treatment for it were still challenging and its result was poor. Until date, only one successful surgical treatment for a case complicated by DIC and cerebral infarctions has been reported, and our report describes second such case of successful resection. Even though this report is limited to a case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.

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A large cardiac myxoma (60 × 35 mm in diameter) with a stem attached to the septum of the atrial wall, which prolapsed into the left ventricle during the diastolic phase.
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Figure 1: A large cardiac myxoma (60 × 35 mm in diameter) with a stem attached to the septum of the atrial wall, which prolapsed into the left ventricle during the diastolic phase.

Mentions: His physical examination revealed a temperature of 39.5°C and a blood pressure of 80/40 mmHg and a heart rate of 120 beats/min. He had multiple embolic lesions on the distal portion of his extremities. He was delirious and a brain magnetic resonance imaging (MRI) showed multiple small infarctions but fortunately no haemorrhage was detected. Laboratory data revealed a white blood cell count of 13000/mm3 and a C-reactive protein level of 30.0 mg/dl. His platelet count was only 1.0 × 104/mm3 and D-dimer was 12.72 μg/ml, which indicated severe DIC. Echocardiography showed a large mass (60 × 35 mm in diameter) with a stem attached to the septum of the atrial wall, which prolapsed into the left ventricle during the diastolic phase with trivial mitral regurgitation (Figure 1).


Successful surgical resection of infected left atrial myxoma in a case complicated with disseminated intravascular coagulation and multiple cerebral infarctions: case report.

Yoshioka D, Takahashi T, Ishizaka T, Higuchi T - J Cardiothorac Surg (2011)

A large cardiac myxoma (60 × 35 mm in diameter) with a stem attached to the septum of the atrial wall, which prolapsed into the left ventricle during the diastolic phase.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108288&req=5

Figure 1: A large cardiac myxoma (60 × 35 mm in diameter) with a stem attached to the septum of the atrial wall, which prolapsed into the left ventricle during the diastolic phase.
Mentions: His physical examination revealed a temperature of 39.5°C and a blood pressure of 80/40 mmHg and a heart rate of 120 beats/min. He had multiple embolic lesions on the distal portion of his extremities. He was delirious and a brain magnetic resonance imaging (MRI) showed multiple small infarctions but fortunately no haemorrhage was detected. Laboratory data revealed a white blood cell count of 13000/mm3 and a C-reactive protein level of 30.0 mg/dl. His platelet count was only 1.0 × 104/mm3 and D-dimer was 12.72 μg/ml, which indicated severe DIC. Echocardiography showed a large mass (60 × 35 mm in diameter) with a stem attached to the septum of the atrial wall, which prolapsed into the left ventricle during the diastolic phase with trivial mitral regurgitation (Figure 1).

Bottom Line: Cardiac myxoma is the most common primary cardiac tumour, but infected cardiac myxoma is relatively rare.Until date, only one successful surgical treatment for a case complicated by DIC and cerebral infarctions has been reported, and our report describes second such case of successful resection.Even though this report is limited to a case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular surgery, Osaka National Hospital, 2-14 Hoenzaka, Chuo-ku, Osaka city, Osaka, 540-0006, Japan.

ABSTRACT
Cardiac myxoma is the most common primary cardiac tumour, but infected cardiac myxoma is relatively rare. Infected cardiac myxoma is very fragile, and has a potential to lead to catastrophic disorder with systemic bacteremia, systemic mycotic embolism, and disseminated intravascular coagulation (DIC).We present here the successful surgical treatment of a case of infected left atrial myxoma with septic shock, DIC and cerebral infarction without hemorrahage. Collective review of 58 reported cases with infected cardiac myxoma revealed that surgical treatment for it were still challenging and its result was poor. Until date, only one successful surgical treatment for a case complicated by DIC and cerebral infarctions has been reported, and our report describes second such case of successful resection. Even though this report is limited to a case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.

Show MeSH
Related in: MedlinePlus