Atrial Myxomas Causing Severe Left and Right Ventricular Dysfunction

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Abstract

Myxomas are the most common cardiac tumors, accounting for about 50% of benign primary cardiac tumors, with the majority located in the left atrium, and 80% of which originate in the interatrial septum. We report two cases with severe cachexia, neurological sequelae, and severe biventricle dysfunction secondary to atrial myxomas with marked early improvement after tumor excision.

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The role of interleukin-6 in cases of cardiac myxoma. Clinical features, immunologic abnormalities, and a possible role in recurrence.

C Mendoza, M. Rosado, Christopher Bernal (2000)

We performed this prospective study to evaluate the correlation of interleukin-6 serum levels with preoperative constitutional symptoms and immunologic abnormalities, and the possible role played by this cytokine in tumor recurrence. Eight patients with atrial myxoma were evaluated at our institution from July 1993 to November 1998. We measured their interleukin-6 serum levels by enzyme-linked immunosorbent assay method preoperatively and 1 and 6 months after surgery. Two of the cases involved recurrent tumor, 1 patient had undergone his 1st surgery at a different institution and died during the 2nd procedure, so his data were incomplete. Preoperatively the whole group of patients had elevated interleukin-6 serum levels. Although patients with a 1st occurrence of tumor demonstrated a positive correlation between interleukin-6 serum level and tumor size, the 2 patients with recurrent tumors appeared to have higher interleukin-6 levels regardless of tumor size. Once the tumor was surgically removed, interleukin-6 levels returned to normal values, and this was associated with regression of clinical manifestations and immunologic features. According to our study, the overproduction of interleukin-6 by cardiac myxomas is responsible for the constitutional symptoms and immunologic abnormalities observed in patients with such tumors and might also play a role as a marker of recurrence. This study also suggests that recurrent cardiac myxomas form a subgroup of cardiac myxomas with a highly intrinsic aggressiveness, as implied by their greater interleukin-6 production despite their smaller size. Further studies are needed to confirm these results.

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Relationship of interleukin-6 with regional and global left-ventricular function in asymptomatic individuals without clinical cardiovascular disease: insights from the Multi-Ethnic Study of Atherosclerosis.

Alban Redheuil, Lindsey B. Rosen, Bruno C L M Rocha … (2010)

We sought to examine the relationship between circulating interleukin-6 (IL-6) level and regional left-ventricular (LV) function among apparently healthy individuals free of cardiovascular disease. Using magnetic resonance myocardial tagging, we determined peak systolic circumferential strain (Ecc) as a measure of regional systolic function in 894 asymptomatic participants in the Multi-Ethnic Study of Atherosclerosis. Ecc was analysed by harmonic phase imaging separately in the LV anterior wall, septum, lateral wall, and inferior wall. Global Ecc was calculated as the average of Ecc in all myocardial segments. We performed multivariable linear regression to evaluate the independent associations between log IL-6 and Ecc, after adjusting for demographic features, cardiovascular risk factors, and markers of subclinical atherosclerosis. The inverse relationships between IL-6 and absolute Ecc were similar in both genders. In multivariable analysis, higher IL-6 level was independently associated with reduced systolic function (less negative Ecc) in the septum [regression coefficient = 1.03 per unit higher log IL-6, 95% confidence interval (CI) 0.26-1.79, P = 0.008] and inferior wall (regression coefficient = 1.65, 95% CI 0.74-2.56, P < 0.001), but not in the anterior wall (P = 0.27) or lateral wall (P = 0.52). Overall, there was an independent inverse association between IL-6 and global Ecc (regression coefficient = 0.94, 95% CI 0.37-1.51, P = 0.001). Compared with C-reactive protein, higher IL-6 level demonstrates a stronger independent association with reduced regional systolic function. In asymptomatic men and women without documented cardiovascular disease, there is a strong, independent, inverse relationship between IL-6 and regional LV systolic function. These findings suggest that IL-6 may underlie the pathogenetic link between inflammation, LV dysfunction and incipient heart failure. The observed variable relationships between IL-6 and systolic function across different LV regions warrant further investigations.

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Biatrial myxoma: a case report and review of the literature.

Adel Irani, Anthony L Estrera, L. Buja … (2008)

In surgical series, a majority of benign cardiac tumors are myxomas. Of these, only about 2.5% are biatrial. Only 10 cases have been reported in the last 10 years. We present here a successful case in a 51-year-old man. A brief review of the literature is presented to place this case in context. The tumor was removed surgically via a midline sternotomy using cardiopulmonary bypass. Both left and right atrial extensions of the tumor mass were removed. The resection involved the entire septum, with a bovine patch used to reconstruct the atrial septum. Patient recovered uneventfully. We advised follow-up evaluation using transthoracic echocardiography annually. Biatrial myxoma is a very rare condition, with diagnostic challenges, but is amenable to modern surgical approaches.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Card Anaesth

Journal ID (iso-abbrev): Ann Card Anaesth

Journal ID (publisher-id): ACA

Title: Annals of Cardiac Anaesthesia

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-9784

ISSN (Electronic): 0974-5181

Publication date (Print): Oct-Dec 2017

Volume: 20

Issue: 4

Pages: 450-452

Affiliations

[1] Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India

[1 ] Department of Cardiothoracic Vascular Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India

Author notes

Address for correspondence: Dr. Prabhat Tewari, Department of Anaesthesiology, SGPGIMS, Lucknow - 226 014, Uttar Pradesh, India. E-mail: ptewari123@ 123456yahoo.co.in

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Publisher ID: ACA-20-450

DOI: 10.4103/aca.ACA_107_17

PMC ID: 5661318

PubMed ID: 28994684

SO-VID: bfc91603-bcb8-465d-8d32-41445d90d37b

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Atrial Myxomas Causing Severe Left and Right Ventricular Dysfunction

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Most cited references 8

The role of interleukin-6 in cases of cardiac myxoma. Clinical features, immunologic abnormalities, and a possible role in recurrence.

Relationship of interleukin-6 with regional and global left-ventricular function in asymptomatic individuals without clinical cardiovascular disease: insights from the Multi-Ethnic Study of Atherosclerosis.

Biatrial myxoma: a case report and review of the literature.

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