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Real-time three-dimensional echocardiographic: Assessment in left atrial myxoma
Clinical Case Portal
Date of publication:
24 Oct 2011
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Topics: |
Cardiac Tumours
Non-invasive imaging: Echocardiography, MR/CT, Nuclear
Echocardiography (Non-invasive imaging)
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Authors:
Gianluca Alunni MD, Del Grosso Angela MD, Mauro Giorgi MD, Sebastiano Marra MD
Authors details:
Azienda Universitario-Ospedaliera S. Giovanni Battista Molinette Turin, Italy
Contact:
Gianluca Alunni
a.gianluca1@virgilio.it
phone 39116335564
Introduction
Left atrial myxoma is the most common primary cardiac tumor (1). It maybe occasionally found on routine examinations of asymptomatic patients. Echocardiography is the technique of choice for detecting and assessing prognosis of cardiac masses, wheteher they are thrombi, vegetations, or tumors. 2D echocardiography is limited to planar imaging which provides representative measures for symmetric structures, but not for asymmetric masses.
Real-time three-dimensional echocardiography (RT3DE) is a new technique capablke to acquire a pyramidal volume of information. This volume can then be rotated and cropped to focus on any region of interest contained in the volume (2-3).
Only few cases of 3-dimensional echocardiographic imaging of left atrial myxomas can be found in the literature (4-5). We report the case of a patient with left atrial myxoma, in whom 3-dimensional echocardiography was useful for detailing the anatomical features of the tumor.
Case Report
A 42-year-old woman, with no history of cardiovascular disease, was admitted at a community hospital for suspected ischemic stroke. Systemic thrombolysis was started. The day after, a transthoracic echocardiogram showed a large mass in the left atrium prolapsing into ventricle during diastole. The patient was transferred to our Institution for surgical treatment The transthoracic echocardiogram confirmed the presence of an hyperechogenic mass probably attached to the interatrial septum and prolapsing into the left ventricle during diastole(Fig 1, 2). The peduncle was not visualized. With RT3D echocardiogram the size and morphological characteristics of the mass were detailed. In addition, small pedicle was detected originating from the interatrial septum (Fig 3,4,5,6,7,8). These images were enough to submit the case to cardiac surgery. The day after the patient was operated and the operative findings confirmed the information provided by RT3DE.
Conclusion
In the reported case, the 3-dimensional reconstruction of the tumor and surrounding structures allowed a better anatomical characterization of the mass and identification of the pedicle attached to the interatrial septum.
In current clinical practice, the 3-dimensional echocardiographic technique proved to be useful for the anatomical identification of structural heart diseases. These findings suggest that RT3DE may be the technique of choice for the non invasive evaluation of intracardiac mass.
References
- Bulckley BH, Hutchincs GM. Atrial myxomas: a thirty-years review. Am Heart J 1979; 97: 639-43
- Sugeng L, Wernert L, Lang RM: left ventricular assessment using real time three dimensional echocardiography. Heart 2003; 89 (suppl. 3): iii 29-iii36
- Espinola-Zabaleta N, Hernandez Morales G, Vargas Barron J et al: Three dimensionale transesophageal echocardiography in tumors of the heart. J Am Soc Echocardiogr 2002; 15:972-979
- Melzer C, Bartel T, Baumann G: Dynamic 3D echo in the preoperative assessment of the left atrial mixoma in a 51-year-old male. Cardiology 1997; 59: 167-69
- Petre R, Vuille C, Diebold-Berger S, et al. Three dimensional imaging of atrial myxoma. Circulation 1998; 97: 2186-7
- Harada T, Ohtaki T, Sumyoshi T et al. Sucessful three-dimensional reconstruction using transesophageal echocardiography in a patient with left atrial myxoma. Jpn Heart J 2001; 42: 789-92
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