Residual Left Atrial Mass After Myxoma Resection

Published:August 14, 2014DOI:
      A 68-YEAR-OLD WOMAN was admitted to the authors’ institution complaining of shortness of breath and chest pain. Her workup demonstrated a large (5 cm×5 cm) atrial mass by transthoracic echocardiography. She subsequently was scheduled for resection. On the day of surgery, transesophageal echocardiography confirmed the presence of this large, pedunculated left atrial mass, which originated from the interatrial septum just proximal to the orifice of the right superior pulmonary vein. Its visual appearance resembled that of a myxoma. The rest of the transesophageal echocardiography (TEE) examination was unremarkable (Fig 1 and Video 1). The atrial mass was resected completely, including a 1.5 cm×2 cm segment of the interatrial septum, consistent with the attachment site of the tumor. This defect in the interatrial septum was reconstructed with a pericardial patch. The atrium was closed and the patient successfully weaned off cardiopulmonary bypass. Immediately after cardiopulmonary bypass, repeat TEE found a small mass in the left atrium (Fig 2, Fig 3; Appendix A, Appendix A). What is the diagnosis?
      Figure thumbnail gr1
      Fig 1Midesophageal four-chamber view showing the large left atrial myxoma.
      Figure thumbnail gr2
      Fig 2Midesophageal bicaval view showing a “residual mass” in the left atrium.
      Figure thumbnail gr3
      Fig 3A three-dimensional view showing the atriotomy suture line and a residual mass.

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