475 A Case of Left Atrial Myxoma Associated with Atrial Septal Defect Feridun Kosar, M.D., ∗ Nevzat Erdil, M.D.,† Hakan Gullu, M.D., ∗ Ibrahim Sahin, M.D.,† Vedat Nisanoglu, M.D.,† and Bektas Battaloglu M.D.‡ * Department of Cardiology; †Cardiovascular Surgery; and ‡Internal Medicine, Inonu University, Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey ABSTRACT Cardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associ- ated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-old woman referred to the emergency department with loss of consciousness and finally diagnosed as a ped- inculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septal defect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture. The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagno- sis when patients present with neurological consequences of systemic embolization. doi: 10.1111/j.1540- 8191.2005.200469.x (J Card Surg 2005;20:475-477) INTRODUCTION Myxoma is the most common type of primary tumors of the heart. 1,2 It is usually benign in nature, and com- monly occurs between the third and the sixth decade of life. Approximately 75% of myxomas originate from the left atrium, and more than 90% are solitary. 1,2 More im- portantly, myxomas are quite infrequently associated with congenital cardiac anomalies such as atrial septal defect. 3-5 Cardiac myxoma can produce a wide spec- trum of systemic findings including systemic and pul- monary embolism, and intracardiac obstruction. 6-9 The neurological consequences of systemic embolization include transient ischemic attacks, stroke, seizures, and syncope. 9 Mobile and/or pedinculated left atrial myxomas may prolapse to various degrees into the mi- tral valve orifice, infrequently resulting in obstruction of AV blood flow and mitral regurgitation. Therefore, the signs and symptoms of myxomas often mimic those of mitral valve disease. In this report, we describe a patient who had a ped- inculated mobile myxoma in the left atrium associated with an ostium secundum type atrial septal defect. CASE REPORT A 72-year-old woman was evaluated in the emer- gency department for loss of consciousness. This was her first episode, and her detailed medical history re- vealed dyspnea on exercise and episodes of palpita- tion. On her physical examination, there was a grade 2- 3/6 systolic ejection murmur that was most prominent at the left second intercostal space. An ECG record- ing showed normal sinusal rhythm and nonspecific ST-T wave changes in precordial derivations. Chest Address for correspondence: Nevzat Erdil, M.D., Inonu University, Faculty of Medicine, Department of Cardiovascular Surgery, 44315 Malatya, Turkey. Fax: +90 422 3410728; e-mail: nerdil@inonu.edu.tr X-ray showed normal cardiothoracic ratio. Laboratory tests were nonspecific and nondiagnostic. Also, her cranial computed tomography revealed an ischemic necrotic zone in the brain. Since the patient com- plained of dyspnea and palpitation, and had a sign of cerebrovascular event, transthoracic echocardiog- raphy was immediately performed after hospitaliza- tion. Two-dimensional transthoracic echocardiogram showed that there was a pedinculated mobile mass in the left atrium (Fig. 1). The mass was lobulated and pedinculated in shape and it had been connected to the posterior wall of the left atrium thorough a pedincu- lum, and it was prolapsing into the mitral valve orifice reaching at the tips of the mitral valves without ob- structing mitral valve orifice. Her clinical and echocar- diography findings pointed out atrial myxoma. Trans- esophageal echocardiography clearly demonstrated a lobulated and pedinculated mobile nonhomogenous mass with a broad base of 15 mm attached to the posterior wall of the left atrium (Fig. 2A), and also re- vealed a left to right shunt thorough the atrial septal defect demonstrating an ostium secundum type atrial septal defect which was measured 12 mm in diameter (Fig. 2B). To exclude any underlying occult coronary artery disease, and to demonstrate the vascular supply to tumor, coronary angiography was performed prior to cardiac surgery. Coronary angiograms revealed that there was no atherosclerotic lesion including wall irreg- ularities and no collateral vessels. The mass was successfully excised from the left atrium, and atrial septal defect was closed with primary suture. Histologic examination of the mass confirmed a benign myxoma including a lax connective tissue with myxomatous cells together with endothelial cells, macrophages, and muscle cells. The patient made an uneventful recovery in the postoperative period, and he is currently well after surgery.