Severe, Reversible Pulmonary Hypertension From Giant Pedunculated Left Atrial Myxoma

J INVASIVE CARDIOL 2019;31(9):E273.

Key words: heart failure, myxoma, polypoid mass

A 77-year-old female with a background of obstructive sleep apnea presented with a 3-week history of dyspnea on exertion and leg swelling. She had a dry cough and had lost 10 kg over the prior 2 years.

Examination revealed elevated jugular venous pressure, reduced air entry in the left lower lung field, and pedal edema. Transthoracic echocardiography demonstrated a large left atrial mass that appeared tethered to the interatrial septum and extended deep into the left ventricle in diastole, causing severe restriction of flow through the mitral valve. The left ventricle had normal size and function. The right ventricle was moderately dilated with impaired systolic function. She had moderate tricuspid regurgitation and severe pulmonary hypertension (right ventricular systolic pressure, 78 mm Hg) (Video 1). A chest computed tomography scan showed the left atrial mass and a small left-sided pleural effusion (Figure 1A). Surgical resection of the mass was performed via median sternotomy. The resected polypoid mass was measured at 14.0 x 5.5 x 3.0 cm (Figure 1B). Macroscopically, the specimen had mucoid and papillary excrescences. Histological findings confirmed a diagnosis of benign cardiac myxoma. Postoperatively, the patient had paroxysmal atrial fibrillation that ceased within a few hours. Signs of heart failure (and obstructive sleep apnea) resolved within 1 week. Repeat transthoracic echocardiography 6 weeks later showed no significant valve disease and normalization of pulmonary artery pressures.

Atrial myxoma is an unusual cause of severe pulmonary hypertension, and is reversible with treatment.

Acknowledgment. The authors would like to thank Dr Prateek Suri, Dr Ian Nicholson, and Timothy Mclellan for their help with this case.

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From ¹Gosford Hospital, Gosford, New South Wales, Australia; and ²University of Sydney, Sydney, New South Wales, Australia.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 16, 2019.

Address for correspondence: Paul Bamford, MBChB, Gosford Hospital, Gosford, NSW 2280, Australia. Email: paul.bamford@gmail.com