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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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Related in: MedlinePlus

(A): The gross pathological findings were a very fragile myxoid tumor (allow head) attached the septal wall (allow) with the red thrombus and vegetation (*). (B): Hematoxylin and eosin (HE) and showed that the mass was an atrial myxoma, and gram staining of the infected portion revealed the presence of gram-positive coccal bacteria.
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Figure 2: (A): The gross pathological findings were a very fragile myxoid tumor (allow head) attached the septal wall (allow) with the red thrombus and vegetation (*). (B): Hematoxylin and eosin (HE) and showed that the mass was an atrial myxoma, and gram staining of the infected portion revealed the presence of gram-positive coccal bacteria.

Mentions: An urgent operation was performed using tepid hypothermic cardiopulmonary bypass (CPB) and the usual dose of systemic heparinization. The tumor was completely excised with the attached atrial septum via a trans-septal approach. A small amount of vegetation was observed in the posterior mitral chordae, which was carefully excised without injuring the mitral structure. The gross pathological findings were a very fragile myxoid tumor with the red thrombus (Figure 2A). The platelet concentrate and fresh frozen plasma were transfused after the end of CPB and complete hemostasis was achieved.


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): The gross pathological findings were a very fragile myxoid tumor (allow head) attached the septal wall (allow) with the red thrombus and vegetation (*). (B): Hematoxylin and eosin (HE) and showed that the mass was an atrial myxoma, and gram staining of the infected portion revealed the presence of gram-positive coccal bacteria.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: (A): The gross pathological findings were a very fragile myxoid tumor (allow head) attached the septal wall (allow) with the red thrombus and vegetation (*). (B): Hematoxylin and eosin (HE) and showed that the mass was an atrial myxoma, and gram staining of the infected portion revealed the presence of gram-positive coccal bacteria.
Mentions: An urgent operation was performed using tepid hypothermic cardiopulmonary bypass (CPB) and the usual dose of systemic heparinization. The tumor was completely excised with the attached atrial septum via a trans-septal approach. A small amount of vegetation was observed in the posterior mitral chordae, which was carefully excised without injuring the mitral structure. The gross pathological findings were a very fragile myxoid tumor with the red thrombus (Figure 2A). The platelet concentrate and fresh frozen plasma were transfused after the end of CPB and complete hemostasis was achieved.

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