A Case of Infected Left Atrial Myxoma Presenting as ST-Elevation Myocardial Infarction (STEMI).

BACKGROUND Although left atrial myxoma is the most common benign primary cardiac tumor, infected atrial myxoma is rare. This report presents a case of infected left atrial myxoma with embolization to the left anterior descending (LAD) coronary artery, which was identified following an initial presentation with ST-elevation myocardial infarction (STEMI). CASE REPORT A 34-year-old man with a history of smoking tobacco and intravenous cocaine use presented to the emergency room with symptoms of a feeling of pressure on the chest and symptoms in the left arm. An electrocardiogram (ECG) showed ST elevation in leads II, III, aVF, and V3-V5, consistent with an anterior-inferior STEMI. He underwent percutaneous intervention (PCI) with two drug-eluting stents to the mid-distal LAD coronary artery. The patient also had fever, chills, a history of weight loss, and signs of peripheral emboli. Blood cultures identified Gram-positive Streptococcus parasanguinis, a member of the Streptococcus viridans group. Transesophageal echocardiogram (TEE) identified a large, mobile, pedunculated left atrial mass protruding into the mitral valve in diastole and mitral valve vegetations. Surgical excision and the histology confirmed a diagnosis of benign left atrial myxoma containing Gram-positive cocci. The patient required mitral valve replacement and a postoperative two-week course of gentamicin and a six-week course of ceftriaxone CONCLUSIONS A rare case is reported of infected left atrial myxoma presenting as STEMI secondary to coronary artery embolization, which was treated with PCI, antibiotics, and mitral valve replacement.

Transaortic video-assisted resection of a recurrent left ventricular myxoma.

An asymptomatic 57-year-old woman presented for resection of a fifth cardiac myxoma. To avoid complete redissection of the heart, we proposed a video-assisted transaortic approach for a recurrent left ventricle (LV) myxoma resection. In a hybrid approach, sternotomy and open aortotomy provided the minimally invasive transaortic access to the myxoma. The myxoma was discovered during a routine echocardiographic screening. A 30° 5-mm scope, video-assisted thoracic surgery graspers, and endoshears were used for resection. The video-assisted technique significantly enhanced the intracardiac visualization, and a smaller, second myxoma was discovered after resection of the primary lesion. Both myxoma beds were additionally ablated to prevent recurrence. The total video-assisted operating time was 58 minutes. The transaortic valve approach avoided an atriotomy or ventriculotomy in a fifth redo operation. A transaortic valve approach to LV intracardiac lesions is safe and feasible, and it provides excellent visibility for complex cardiac cases.

The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance.

BACKGROUND: Assessment of right ventricular (RV) function remains challenging because of complex RV chamber geometry and a paucity of easily derived and objective functional methods. METHODS: Visual 2-dimensional echocardiographic estimates of RV ejection fraction (EF), tricuspid annular plane systolic excursion, Doppler tissue imaging, and myocardial performance index (MPI) were compared with biplanar Simpson's rule RV EF in 101 consecutive patients. Data were analyzed using simple linear regression and receiver operating characteristic curves. RESULTS: RV EF was significantly correlated with tricuspid annular plane systolic excursion (r = 0.48, P <.0001), Doppler tissue imaging peak systolic velocity (r = 0.45, P <.0001), and MPI (r = -0.38, P =.006). Using a Simpson's RV EF < 50%, the sensitivity, specificity, and positive and negative predictive values of tricuspid annular plane systolic excursion < 1.5 cm were 59%, 94%, 71%, and 89%; of Doppler tissue imaging peak systolic velocity < 10 cm/s were 59%, 92%, 67%, and 89%; and of MPI < 0.40 were 100%, 35%, 29%, and 100%, respectively. The area under the receiver operating characteristic curves was similar for the 3 indices. CONCLUSIONS: Measurements of tricuspid annular motion are easy to obtain, correlate with Simpson's RV EF, and have a high specificity and negative predictive value for detecting abnormal RV systolic function; and the MPI, although not specific, has high sensitivity and negative predictive value for detecting abnormal RV systolic function.

FIRST HEART SOUND ALTERNANS IN MASSIVE PERICARDIAL EFFUSION.

First heart sound alternans in the absence of pulsus alternans, or variation in heart rate (i.e., variation in PR interval), occurring in a patient with massive neoplastic pericardial effusion is described. The mechanism appears to be similar to that in electrical alternans and is shown by echocardiography to be related to the cardiac position within the pericardium, with the first heart sound intensity varying according to the distance of the heart from the chest wall. First heart sound alternans, electrical alternans, and alternating cardiac motion within the pericardium disappeared following pericardiocentesis.