Diagnosis and treatment of a left atrial myxoma originating from an atrial septal defect closure device: a case report

Author:

Mastrangelo Angelo1ORCID,Olivares Paolo1,Giambuzzi Ilaria2,Muratori Manuela3,Alamanni Francesco45,Bartorelli Antonio L16

Affiliation:

1. Department of Interventional Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Via Carlo Parea 4, 20138 Milan , Italy

2. Department of Cardiac Surgery, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Via Carlo Parea 4, 20138 Milan , Italy

3. Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Via Carlo Parea 4, 20138 Milan , Italy

4. Department of Cardiac Surgery, Istituto Clinico Sant’Ambrogio , Via Privata Val Vigezzo 5, 20149 Milan , Italy

5. Department of Clinical Sciences and Community Health, University of Milan , Via Festa del Perdono 7, 20122 Milan , Italy

6. Department of Biomedical and Clinical Sciences, University of Milan , Via Festa del Perdono 7, 20122 Milan , Italy

Abstract

Abstract Background Ostium secundum atrial septal defect (osASD) is a common congenital heart disease and transcatheter closure is the preferred treatment. Late device-related complications include thrombosis and infective endocarditis (IE). Cardiac tumours are exceedingly rare. The aetiology of a mass attached to an osASD closure device can be challenging to diagnose. Case summary A 74-year-old man with atrial fibrillation was hospitalized for evaluating a left atrial mass discovered incidentally 4 months earlier. The mass was attached to the left disc of an osASD closure device implanted 3 years before. No shrinkage of the mass was observed despite optimal intensity of anticoagulation. We describe the diagnostic workup and management of the mass that at surgery turned out to be a myxoma. Discussion A left atrial mass attached to an osASD closure device raises the suspect of device-related complications. Poor endothelialisation may promote device thrombosis or IE. Cardiac tumours (CT) are rare, and myxoma is the most common primary CT in adults. Although no clear relationship exists between the implantation of an osASD closure device and a myxoma, the development of this tumour is a possible occurrence. Echocardiography and cardiovascular magnetic resonance play a key role in the differential diagnosis between a thrombus and a myxoma, usually identifying distinctive mass features. Nevertheless, sometimes non-invasive imaging may be inconclusive, and surgery is necessary to make a definitive diagnosis.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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