Left Atrium Myxoma, Open - Female, 73 Years

Left Atrial Myxoma:
Atrial myxoma is the most common primary tumor of the heart, originating from the inner
lining or Endocardium. Tumors involving the heart can be classified as primary (originating
in the heart) or secondary (Metastatic spread from another part of the body to the heart).
Metastases are more common, typically present in late-stage disease, and can occur in 1-
20% of cancer patients, depending on the type of primary tumor. Primary cardiac tumors
are rare and range from 0.02-0.3% of the population. Atrial myxomas are benign but can
still be life-threatening due to their location in the left atrium, where it may obstruct blood
flow through the mitral valve, cause arrhythmias, or embolize to other organs. They are
slow-growing tumors, which are most commonly present due to obstructive symptoms
(shortness of breath, fainting, fatigue or palpitations, pulmonary hypertension, or heart
failure) and less commonly due to embolic symptoms such as stroke, organ infarction, or
peripheral artery occlusion.

Anatomy: Left Atrium
The left atrium (LA) is one of four chambers of the heart that receives oxygenated blood
from the lungs through the 4 pulmonary veins (2 from the left lung and 2 from the right
vein). It delivers oxygenated blood through the mitral valve into the left ventricle, which is
then pumped to the rest of the body. The left atrium contains unique anatomic features,
including the left atrial appendage, a small ear-shaped muscular pouch whose function,
while not entirely understood, helps regulate cardiac output and blood pressure and
contracts during diastole. It is a common place for thrombus to form during arrhythmias
such as atrial fibrillation and may need to be surgically occluded or occluded through
minimally invasive procedures. The interatrial septum separates the left and right atrium
and is the most common site for atrial myxomas to arise. The Mitral valve is a bicuspid
valve separating the left atrium from the left ventricle and ensures one-way blood flow into
the ventricle when normal.

Diagnosis:
Atrial myxomas are diagnosed through imaging, including transthoracic echocardiography
(TTE), transesophageal echocardiography (TEE), Cardiac CT, or Cardiac MRI. Although not
always present, a triad of symptoms of mitral valve obstructions, embolism, and
constitutional symptoms can lead to further investigation, commonly starting with
echocardiography.

Treatment:
In most cases, surgical excision is the mainstay of treatment and curative with an excellent
long-term prognosis. Follow-up imaging may be used to monitor for recurrence or residual
disease after surgery.