2023 FSA Podium and Poster Abstracts

P071: A CASE REPORT OF RARE BIATRIAL MYXOMA RESECTION
Amy Quintero, MD; Harshvardhan Rajen, MD; Jason Hall, MD; HCA Florida Aventura Hospital

Introduction/Background: Cardiac myxomas are the most common primary cardiac tumor, but are relatively rare with a reported prevelance of 0.03% (1). The left atrium is the site most commonly affected. Atrial myxomas are associated with a triad of complications including obstruction, emboli and constitutional symptoms (Due to release of IL-6). Cardiac myxomas which arise from two different heart chambers is extremely rare. This case examines a 53 year old female with a past medical history of hypertension who presented to the hospital complaining of abdominal pain, headaches and left sided numbness and tingling. Patient was found to have an embolic stroke with atrial myxoma. A transthoracic echocardiogram performed demonstrated a left atrial mass.

Methods: Patient was scheduled for surgical resection of the myxoma. A 9 French cordis was inserted preoperatively in the right internal jugular vein for vascular access. A right radial a line was also done preoperatively to assess hemodynamics and for frequent blood sampling. Patient was induced and airway was secured with an endotracheal tube. Transesophageal echocardiogram performed demonstrated a preserved left ventricular function, a left atrial and right atrial mass with a stalk extending to the atrial septum. Bilateral cerebral oximetry monitored for cerebral perfusion throughout case. No significant valvulopathy was appreciated on TEE. Surgery performed via sternotomy incision and patient was placed on cardiopulmonary bypass for resection of tumors. Patient tolerated weaning off CPB and TEE was used to confirm mass had been completely excised and there was no residual connection between the left atrium and right atrium, ejection fraction was preserved.

Results: Patient was extubated on post op day 1 with significant improvements over the following days. She was discharged on post op day 6 with follow up appointment scheduled.

Discussion/Conclusion: Biatrial myxomas account for fewer than 2.5% of cases of cardiac myxomas, a rare primary cardiac tumor. Once a diagnosis is established, these tumors should be removed to prevent further cardiac or neurologic sequalae. In this rare case of bilateral atrial myxoma, a transthoracic echocardiogram was insufficient to evaluate both atrial myxomas. Intraoperative TEE for visualization and characterizations was imperative to assess for full tumor extent and allow surgical planning.