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Journal ArticleDOI

Cerebral angiography in cardiac myxoma. Correlation of angiographic and histopathological findings

01 Aug 1970-Radiology (Radiology)-Vol. 96, Iss: 2, pp 335-345
TL;DR: A report of 3 cases illustrates the cerebral angiographic findings which can be encountered in left atrial myxoma with cerebral embolization, and suggests this rare variety, neoplastic, should probably be added to the classical six varieties of aneurysm.
Abstract: A report of 3 cases illustrates the cerebral angiographic findings which can be encountered in left atrial myxoma with cerebral embolization. Since there apparently has been no previous record of the pathological basis of the unusual developments in chronic stages of the embolization, neuropathological findings at autopsy in one patient have been extensively described. Recognition of these angiographic features may be of major significance in establishing diagnosis. To the classical six varieties of aneurysm should probably be added this rare variety, neoplastic, since some of these aneurysms have sufficient remaining elements of the arterial wall to be classified as true aneurysms.
Citations
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Journal ArticleDOI
TL;DR: In this paper, the authors retrospectively reviewed the medical records of 74 consecutive patients with pathologically confirmed cardiac myxoma at the Mayo Clinic from January 1, 1993, through December 31, 2004.
Abstract: Background Neurologic complications can be the initial manifestation of atrial myxoma. Prompt diagnosis is of paramount significance to prevent recurrent complications. Objective To identify patients with neurologic complications attributed to atrial myxoma. Design, Setting, and Patients With institutional review board approval, we retrospectively reviewed the medical records of 74 consecutive patients with pathologically confirmed cardiac myxoma at the Mayo Clinic from January 1, 1993, through December 31, 2004. Main Outcome Measures Discharge and follow-up modified Rankin score. Results Nine of the 74 patients with cardiac myxoma (12%) presented with neurologic manifestations in the setting of atrial myxoma. Mean age was 48.5 years (range, 17-70 years). There were 6 females and 3 males. Among patients with myxoma and neurologic symptoms, ischemic cerebral infarct was the most common neurologic manifestation (8 patients [89%]). No patients had concomitant cardiac symptoms. The size of the atrial myxoma was variable, with a mean diameter of 2.7 (range, 0.4-6.5) cm. Most of the atrial myxomas causing neurologic symptoms demonstrated a mobile component on transesophageal echocardiography (8 patients [89%]). Two patients (22%) had pathologic evidence of systemic myxomatous emboli. One patient with intracerebral hemorrhage had pathologically confirmed intracranial metastatic myxoma and myxoma-induced aneurysmal dilatation. Conclusions Neurologic complications are associated with cardiac myxoma in some patients with myxoma and, when they occur, frequently present with cerebral infarction. The mobility, not the size, of the myxoma appears to be related to embolic potential. Potential delayed neurologic complications relevant to patients with tumor embolization include myxoma-induced cerebral aneurysm and myxomatous metastasis, which can mimic the clinical picture of central nervous system vasculitis or infective endocarditis.

205 citations


Cites background from "Cerebral angiography in cardiac myx..."

  • ...Myxomatous tumor cells can penetrate the vessel wall at the site of final lodgment, and tumor emboli can infiltrate via subintimal growth, leading to weakening of the arterial wall and subsequent aneurysm formation.(25,26) This complication can be delayed, and pathologically proven intracranial aneurysms have been reported 5 years after successful left atrial myxoma resection....

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Journal ArticleDOI
TL;DR: The clinical course of 3 men, ages 48 to 64 years, whose left atrial myxoma recurred or metastasized following resection is presented, and radical excision of the atrial septum with prosthetic replacement of the resulting defect is recommended to excise the tumor adequately and help eliminate foci of recurrence.

164 citations

Journal ArticleDOI
TL;DR: It is demonstrated that aneurysms represent a symptom of an underlying vascular disease rather than constituting a disease on their own, and that understanding the morphology and pathology of this structure is important in determining the therapeutic approach.
Abstract: An aneurysm is a focal dilatation of an arterial blood vessel. Luminal forces, such as high blood flow, shear stress and turbulence, are implicated in the pathogenesis of intracranial aneurysms, and luminal characteristics, such as sac size and morphology, are usually essential to the clinical decision-making process. Despite frequent clinical emphasis on the vessel lumen, however, the pathology underlying the formation, growth and rupture of an aneurysm mainly resides in the vessel wall. Research on the morphology and histopathology of the vessel wall reveals that intracranial aneurysms do not constitute a single disease, but are a shared manifestation of a wide range of diseases, each of which has a unique natural history and optimum therapy. This Review classifies intracranial aneurysms by vessel wall pathology, and demonstrates that understanding the morphology and pathology of this structure is important in determining the therapeutic approach. The article concludes that aneurysms represent a symptom of an underlying vascular disease rather than constituting a disease on their own.

153 citations

Journal ArticleDOI
TL;DR: In this article, the authors aimed to review the neurological presentations, including stroke, of cardiac myxoma in this modern era of diagnosis and management, and found that the most common presentation was ischaemic stroke (83% of all patients) most often in multiple sites.
Abstract: Background and aims: Cardiac myxoma is a rare but important cause of stroke, which affects young people. More recently the diagnosis has been enhanced by the use of echocardiograms. We aimed to review the neurological presentations, including stroke, of cardiac myxoma in this modern era of diagnosis and management. Methods : Records of patients with neurological presentations at the Austin and Repatriation Medical Centre and The Northern Hospital were retrieved from 1985 to late 2001, using International Classification of Diseases codes for atrial myxoma. Published literature reports were obtained by using Medline search database. An iterative process of bibliography review was utilised to identify reports not found by primary search. Case demographics, neurological presentations, investigations, treatment and outcome were recorded. Results : From the Austin and Repatriation Medical Centre and The Northern Hospital, 6 cases were reported in detail and 107 cases from the published literature were analysed. The mean age of all cases was 43 (range 6−82). There was a female to male predominance (3:2). While there were overlapping neurological presentations, the most common presentation was ischaemic stroke (83% of all patients) most often in multiple sites (41%). The other presentations included syncope (28%), psychiatric presentations (23%), headache (15%) and seizures (12%). Commonest means of reaching the diagnosis was by echocardiography. The myxoma was surgically resected in 69% of cases. Of all cases, 24% were autopsy reports, almost all prior to availability of echocardiograms (in mid-1970s). Conclusions : Patients who presented with neurological complications of cardiac myxoma were young and stroke was by far the most common single presentation. Importantly, when all clinical manifestations were considered, almost half were potentially reversible. In recent years, echocardiography has made significant contribution to establishing the diagnosis less invasively. There is uncertainty about the role of anticoagulants. The treatment of choice remains surgical excision, although the timing post stroke is debatable. There is a need for large scale collaborative studies to help refine management strat­egies. (Intern Med J 2004; 34: 243−249)

133 citations

Journal ArticleDOI
TL;DR: This study studied the delayed neurologic complications of left atrial myxoma in 2 patients and analyzed 47 previously published cases, finding that treatment with doxorubicin failed to prevent aneurysm enlargement in one patient.
Abstract: We studied the delayed neurologic complications of left atrial myxoma in 2 patients and analyzed 47 previously published cases. Embolic cerebral infarctions may occur before surgical removal of the primary cardiac tumor, but aneurysm formation and hemorrhage may be delayed, whether or not there is evidence of neurologic disorder at the time of initial surgery. The true incidence of these delayed complications is unknown. Resultant aneurysms may show progressive enlargement, and treatment with doxorubicin failed to prevent aneurysm enlargement in one patient. Better guidelines are needed for clinical management in these patients.

123 citations

References
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Journal ArticleDOI
TL;DR: The surgical procedure, attempted as a last resort, is described, as are the postmortem findings, which points the way to possible surgical cure in similar lesions.
Abstract: A case of intra-atrial myxoma manifested clinically by evidences of mitral stenosis and peripheral emboli is presented in detail. The diagnosis was made during life and confirmed by angiocardiography. The surgical procedure, attempted as a last resort, is described, as are the postmortem findings. This case points the way to possible surgical cure in similar lesions.

224 citations

Journal ArticleDOI

194 citations

Journal ArticleDOI
TL;DR: A case of left atrial myxohemangioendothelioma, diagnosed ante mortem by removing a tumor embolus to the bifurcation of the aorta, which had been misdiagnosed as having had rheumatic heart disease with paroxysmal atrial fibrillation and embolization to the right middle cerebral artery.
Abstract: A case of left atrial myxohemangioendothelioma, diagnosed ante mortem by removing a tumor embolus to the bifurcation of the aorta, is reported. The patient had been misdiagnosed as having had rheumatic heart disease with paroxysmal atrial fibrillation and embolization to the right middle cerebral artery. In retrospect, because of the characteristics of the second heart sound and absence of an opening snap, a rheumatic etiology should have been questioned. The literature regarding embolization of atrial myxomas has been reviewed.

119 citations

Journal ArticleDOI
TL;DR: A short review of this subject is presented and 2 cases in which angiocardiographic and pathologic demonstration of left heart myxomas were coupled with cerebral angiograms showing cerebral vascular abnormalities are reported.
Abstract: Cerebral embolization of tumor tissue is a well known complication in patients with left heart myxomas (11). Surprisingly, cerebral angiography has rarely been employed in evaluation, and, even in the few cases in which it has been performed (2, 3, 6, 15), little discussion of the findings and only one set of reproductions (6) are presented in the literature. The purpose of this paper is to present a short review of this subject and report 2 cases in which angiocardiographic and pathologic demonstration of left heart myxomas were coupled with cerebral angiograms showing cerebral vascular abnormalities. Review Metastatic lesions constitute 90 to 95 per cent of all cardiac tumors, but of the primary tumors approximately 50 per cent are myxomas (13, 14). About 75 per cent arise in the left atrium. The majority of the others originate in the right atrium (14), with only 4 reported in the left ventricle (7, 12, 17, 18). Few typical clinical features exist (4, 5, 8, 9). The lesion may be entirely silent clinica...

91 citations

Journal ArticleDOI
01 Apr 1960-Heart
TL;DR: Three cases, believed to have mitral stenosis and advised to undergo commissurotomy, were found at operation to have a myxoma of the left atrium, and it seems important to review the reported cases to see whether it is possible to distinguish myxomata from mitrals stenosis by means other than angiocardiography.
Abstract: Tumours of the heart are not common. Benjamin (1939) reports the incidence of primary tumours as 0 03 per cent of 40,000 autopsies. Nearly 50 per cent of these primary tumours are myxomata or myxomatous polyps. Yater (1931) (77 cases), Mahaim (1945) (82 cases) and Pritchard (1951) (125 cases) have collected and reported cases and the number reported is probably still less than 250. Approximately 75 per cent of myxomata occur in the left atrium, while almost all the remainder are found in the right atrium. Pritchard (1951) records one myxoma arising in the left ventricle and one from the mitral valve. Young and Hunter (1947) also report a left ventricular myxoma. During the past seven years, from 1951 to April 1958, some 600 operations for the relief of mitral stenosis have been performed at the Toronto General Hospital. Three cases, believed to have mitral stenosis and advised to undergo commissurotomy, were found at operation to have a myxoma of the left atrium. Similar errors in diagnosis have occurred at other centres (Belcher, 1958; Brock, 1956; Chin and Ross, 1957; Fatti and Reid, 1958; Horlick and Merriman, 1957; Likoff et al., 1954). In centres where angiocardiography is used extensively in investigating mitral valve disease, these tumours have been recognized on finding a filling defect of the left atrium (Goldberg et al., 1952; Steinberg et al., 1953; Marions and Odman, 1957). However, in this centre, if the clinical findings leave doubt as to the presence of mitral stenosis or its dominance in a mixed mitral lesion, left heart catheterization and dye injection studies (Gunton et al., 1958) have been found useful and angiocardiography has not been used. To avoid missing our three cases some 600 angiocardiograms would have been necessary. Routine angiocardiography would not therefore seem a practical solution. Thus it seems important to review the reported cases to see whether it is possible to distinguish myxomata from mitral stenosis by means other than angiocardiography.

81 citations