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   Table of Contents      
CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 31-33

Right Atrial Myxoma With Blood Supply From Left Circumflex Artery − A Rare Variant


1 Department of Cardiothoracic and Vascular Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, Delhi, India
2 Department of Pathology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, Delhi, India

Date of Web Publication1-Mar-2017

Correspondence Address:
Swarnika Srivastava
Department of Cardiothoracic and Vascular Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-7438.201097

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  Abstract 

We report a rare case of right atrial (RA) myxoma in a 48 years old male patient who underwent a screening coronary angiography prior to surgery which revealed tumour blush. The tumour vascularity was derived from the left circumflex artery which is a rarity as most RA myxomas are supplied by the right coronary artery or by both right and left coronary arteries.

Keywords: Left circumflex artery, right atrial myxoma, tumour vascularity


How to cite this article:
Srivastava S, Kisku N, Minhas H, Batra V, Raja N. Right Atrial Myxoma With Blood Supply From Left Circumflex Artery − A Rare Variant. MAMC J Med Sci 2017;3:31-3

How to cite this URL:
Srivastava S, Kisku N, Minhas H, Batra V, Raja N. Right Atrial Myxoma With Blood Supply From Left Circumflex Artery − A Rare Variant. MAMC J Med Sci [serial online] 2017 [cited 2019 Dec 8];3:31-3. Available from: http://www.mamcjms.in/text.asp?2017/3/1/31/201097


  Introduction Top


Primary cardiac tumors constitute 0.01–0.3% of all tumours found in humans.[1] Myxoma is a benign tumor of heart most commonly found in left atrium followed by right atrium and ventricles.[1] Tumor vascularity in atrial myxoma is rare.[2] Most of the reported right atrial (RA) myxoma tumors are supplied by the right coronary artery (RCA) mainly or by both right and left coronaries.[2] We present a rare case of RA myxoma with supply from the left circumflex artery alone as evident from a screening coronary angiography.


  Case Report Top


A 48-year-old male presented to the out patient department with the complaints of giddiness with change in posture, especially while bending forward. He had no other complaints. On examination ‘tumor plop’ was heard, and there was no other significant physical finding. Echocardiography revealed a RA mass of size 7 cm × 6 cm attached to interatrial septum [Figure 1]. A routine coronary angiography was performed to rule out coronary artery disease. This incidentally revealed presence of a ‘tumor blush’ in the left circumflex artery territory [Figure 2] and [Figure 3]. Thus the finding signified that the RA mass had its blood supply derived from left circumflex artery.
Figure 1: Echocardiography image showing right atrial myxoma arising from the interatrial septum (arrow)

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Figure 2: Coronary angiography images showing the left circumflex artery supplying the intracardiac tumor

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Figure 3: Coronary angiography image showing a normal right coronary artery with no tumour blush

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Patient was taken up for elective surgery. Aorto-bicaval cardiopulmonary bypass was initiated and trans-right atrium excision of the mass with a portion of the septum was performed. The defect created in the atrial septum was closed directly. The excised mass was 8 cm × 6 cm in size, firm globular and well encapsulated [Figure 4]. Histopathological examination revealed features consistent with myxoma [Figure 5].
Figure 4: Intraoperative image showing the right atrial (RA) myxoma (A) and the cut open gross specimen of the RA myxoma (B)

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Figure 5: Histopathological images with H&E stain showing stellate and polyhedral cells, arranged singly, in small nests or trabeculae with surrounding stroma compose of abundant myxoid material (A and B); positivity of the specimen for calretinin (C)

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Postoperative stay of the patient was uneventful and was discharged on postoperative day 7.


  Discussion Top


Primary cardiac tumor is a rare identity.[1] Amongst them, myxoma is the most common tumor. Generally, left atrial myxoma is the commonest followed by the RA and the ventricular types in the decreasing order of incidence.[3] RA myxoma attached to atrial septum generally presents with features of congestive heart failure or atrial fibrillation.[4] In our case, no such features were present, and the patient was mostly asymptomatic.

Most of the reported cases of RA myxoma have been shown to derive its blood supply from RCA or both the right and the left coronary arteries unlike the left atrial myxomas which most commonly derive its supply from left circumflex artery with a rare few supplied by branches from the RCA.[5],[6] The significance of this tumor vascularity during surgery lies in the fact that there is a possibility of occurrence of a coronary-cameral fistula.[6] Moreover, neovascularisation of myxoma rules out the possibility of thrombus. In our case, the supply was arising exclusively from the left circumflex artery. No such report of RA myxoma deriving its supply exclusively from the left circumflex artery is available to the best possible knowledge of ours.


  Conclusion Top


RA myxoma is a rare entity and a screening coronary angiography may incidentally reveal ‘tumour blush’, that is, tumor vascularity thus confirming the diagnosis of a cardiac tumor differentiating it from a thrombus. Moreover, most cases of RA myxoma derive supply form RCA and in some cases from both the right and left coronary arteries. In this case we report a rare occurrence of a RA myxoma deriving its vascularity solely from the left circumflex artery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Barreiro M, Renilla A, Jimenez JM, Martin M, Al Musa T, Garcia L et al. Primary cardiac tumors: 32 years of experience from a Spanish tertiary surgical center. Cardiovasc Pathol 2013;22:424-7.  Back to cited text no. 1
    
2.
Umeda Y, Matsuno Y, Imaizumi M, Mori Y, Iwata H, Takiya H. Right atrial myxoma with tumor vascularity originated from the left and right coronary arteries. Int J Cardiol 2009;131:e137-9.  Back to cited text no. 2
    
3.
Li H, Guo H, Xiong H, Xu J, Wang W, Hu S. Clinical features and surgical results of right atrial myxoma. J Card Surg 2016;31:15-7.  Back to cited text no. 3
    
4.
Swartz MF, Lutz CJ, Chandan VS, Landas S, Fink GW. Atrial myxomas: Pathologic types, tumor location, and presenting symptoms. J Card Surg 2006;21:435-40.  Back to cited text no. 4
    
5.
Omar HR. The value of coronary angiography in the work-up of atrial myxomas. Herz 2015;40:442-6.  Back to cited text no. 5
    
6.
Oliveira MD, Tamazato AO, de Fazzio FR, Kajita LJ, Ribeiro EE, Lemos PA. Left atrial myxoma hypervascularisation from the right coronary artery: An interesting Cath Lab finding. Case Rep Cardiol 2016;2016:4865439. doi: 10.1155/2016/4865439  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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