320 MED ARH 2009; 63(6) • ORIGINAL PAPERS Clinical, Echocardiographic and Echophonocardiographic Characteristics of the Atrial Myxomas in 22 Years Period 1. INTRODUCTION Atrial myxomas are the most fre- quent tumors of the heart. Left atrial myxomas are about 3-4 times more fre- quent then right (1, 2, 3, 4, 5, 6, 7). Myx- omas are usualy revealed by echocar- diography when become enough large to give symtoms: left or right atrioven- tricular obstruction symptoms and signs 8-10, systemic 11-22 (5, 6, 7), re- spectivelly pulmonary embolisation 23-26 (8, 9) or nonspeciic symptoms 27-32. Very rarely large myxomas are asymptomatic 33-34. TTE sometimes gives false negative indings, while TEE is almost always reliable 35,36. Echo- phonocardiographic examinations have not been found in literature for years 32,38-39, although echophonocardiog- raphy can be usefull in conirmation of auscultatory indings. Surgical removal of the myxomas is always successful, with rare reci- dives 40-42. 2. MATERIAL AND METHODS he retrospective-pro- spective study included 24 atrial myxomas from 1986 to 2008: 13 (54.2%) men and 11(45.8%) women, were aged 35.3±11. Twenty (83.3%) myxomas were found in the left and four (16.7%) in the right atrium. TTE was performed in all patients, TEE in 14 (58.3%), echophonocardiographic examinations in 11 (45.8%). 19 (79.2%) patients were operated in various sur- gical centers, while we have no further data for 5 patients. 3. RESULTS Number of 21 (87.5%) patients had some of symptoms, but three (12.5T%) were quite asymptomatic. In two pa- tients were found previous brachial, re- spectively femoral arterial embolisation. Twenty three myxomas (95.8%)were di- agnosed by TTE, while one was not vis- ible by TTE approach, inspite previous femoral artery embolisation, extracted myxomatosus embolus and search- ing for left atrial myxoma by TTE.TEE was performed in 15 patients and in all cases the tumor was excellently visi- ble. Simultaneous M-mod echopho- nocardiography was performed in 11 patients: eight with left and three with right atrial myxomas. Diastolic mur- mor of variuos intensity was found in 9 cases and early diastolic tumor «plop» in 8. In a large asymptomatic right atrial myxoma was found unusual late diastolic «plop», what was not yet de- scribed except in our case. In 2 patients systolic and diastolic were recorded. 19 myxomas were succesfully excised, but for 5 patients we have no further data. Clinical, Echocardiographic and Echophonocardiographic Characteristics of the Atrial Myxomas in 22 Years Period Marko Buksa, Vjekoslav Gerc, Mirza Dilic, Vesna Loza, Nabil Naser, Sekib Sokolovic, Enisa Hodzic, Snjezana Brdjanovic, Mehmed Kulic Clinic of Heart Disease, Clinical Center of University of Sarajevo, Bosnia and Herzegovina ORIGINAL PAPER SUMMARY INTRODUCTION: Atrial myxomas are the most frequent benign tumors of the heart. Let atrial myxomas are about 3-4 times more frequent then right. Clinical indings reveal atrioventricular obstruction symptoms and signs, symptoms and signs of peripheral arteries or pulmonary artery embolisation and/or nonspeciic symptoms. AIM: Review of atrial myxomas diagnosed at the Clinic of Cardiology in 20 years period and analysis of clinical characteristics, transthoracic echocardiographic (TTE), transesophageal echocardiographic (TEE), and M-mod echophonographic indings. METHODS: TTE is performed in all, but TEE in 16 patients. Simultaneous M-mod echophonocardiographic examination were performed in 11 patients, when optional equipment was applicable. RESULTS: We found 24 atrial myxomas: 19 (79.2%) in let and 5 (20.810%) in right atrium. 21(87.5%) patients had some of the symptoms, but 3 (12.5%) were asymptomatic. TTE was performed in all patients, but we found 1 (2.4%) false negative result. TEE was performed in 14 (58.3%) patients. Echophonocardiographic recordings showed early diastolic tumor «plop» in 10 patients and unusual late diastolic tumor «plop» in one right atrial myxoma, which has not yet been described. CONCLUSIONS: TTE is a reliable method in diagnosis of atrial myxomas, but not in all cases, while TEE has been found as always reliable. Echophonocardiographic recording is useful for conirmation and understanding of auscultatory inding when applicable. Keywords: atrial myxoma, TTE, TEE, echophonocardiography YES NO Symptoms 21 (87.5%) 3 (12.5%) Embolisation 4 (16.6%) 20 (84.4%) Visible by TTE 23(95.2%) 1(4.8%) TEE 15 (61.3%) 9 (38.7%) Echophonocardiography 11(42.9%) 13 (57.1%) Operated 19 (84.4%) 5 (16.6%) Table 1. Clinical, TTE and TEE, and ehophonocardiographic characteristics No Sex Atrium S1 spliting S2-plop Murmur 1 M Let 0.06 0.11 Diastolic 2 F Let 0.05 0.09 Diastolic 3 F Let 0.06 0.10 - 4 F Let 0.06 0.12 Systolic-diastolic 5 M Let 0.04 0.11 Diastolic 6 F Let 0.06 0.10 Systolic-diastolic 7 M Let 0.06 - Diastolic 8 M Right 0.05 0.11 Diastolic 9 F Right 0.04 0.10 Diastolic 10 F Right 0.05 0.12 Diastolic 11 M Right 0.06 0.22 Diastolic Table 2. Echophonocardiographic Findings in Patients With Atrial Myxomas Figure 1. LEFT ATRIAL MYXOMA-TTE-APICAL FOUR CHAMBRE VIEW. LEFT panel-diastole; RIGHT panel-systole with mitral regurgitation;MY-myxoma;LA- let atrium; LV;let ventricle;RV-right ventricle