Coronary steal by left atrial myxoma: a case report
© licensee BioMed Central Ltd. 2009
Received: 21 March 2009
Accepted: 29 April 2009
Published: 18 June 2009
This report describes a 41-year-old man who had atypical angina resulting from coronary steal by left atrial myxoma. The tumor was completely excised and the patient was symptoms free after operation.
Operative treatment was performed by cardiopulmonary bypass on 8-11-2001. The interatrial septum and the myxoma were removed from the right atrium, the mitral annulus was affected and the mitral valve was replaced with a 27 mm Carbomedics prosthesis (carbomedics inc. Austin TX). A pericardial patch was used to close the atrial septum defect.
The histological results were compatible with a myxoma.
The patient was symptoms free when last seen in January 2006.
Left atrial myxomas are the most common benign intracardiac tumors and symptoms include dyspnea, chest pain and syncope . In our patient, atypical angina was the only symptom and an episode of sudden angina with a picture of myocardial infarction was the indication for emergency coronary angiography, which showed an atrial mass vascularized and supplied by a fistula from the circumflex coronary artery. Systemic embolization from left atrial myxomas are frequent, however the involvement of coronary artery is extremely rare and atrial myxoma is an unusual cause of myocardial infarction .
Operation for an atrial myxoma can be undertaken solely on the base of transthoracic echocardiogram study and this is recommended for follow-up of these patients, especially in familial myxomas where late recurrence has been reported. However, there are authors  that recommend that a coronary angiography should be performed preoperatively in all cases.
We do coronary angiography only in patients with angina or in who are at risk for coronary artery disease. Since chest pain is sometimes the only symptom, to perform a coronary angiography is indicates and how in our case the diagnosis can be doing.
With a highly vascularized mass in the left atrium, supplied by the circumflex coronary artery, it is possible to think that the myxoma could explain the onset of myocardial ischemia through a coronary steal effect. This was corroborated in our case by disappearance of the chest pain after surgical excision of the left atrial myxoma.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor - in - Chief of this Journal.
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