Bilobulated atrial myxoma originating from low interatrial septum.

Myxomas are the most common type of primary cardiac tumors. Around 70% of patients who have them are females, 86% occur in the left atrium and more than 90% are solitary. In the left atrium the usual site of attachment is in the fossa ovalis. Less common sites within the left atrium are the mitral valve or in areas near it. This patient, with a left atrial myxoma originating low in the interatrial septum near the mitral valve, is one of the first cases reported in Puerto Rico. The patient is a 41 year old female with no previous history of systemic illnesses who one month prior to admission developed episodes of chest pain and shortness of breath. A 2D echo, done by a local physician, revealed a mobile left atrial mass causing diastolic obstruction of the valve. She was referred to our institution for further evaluation. A transesophageal echo was done showing a large bilobulated mass connected to the lowermost portion of the atrial septum, close to the mitral annulus, specially to the anterior leaflet. It also showed concurrent mitral regurgitation caused by the mass. The tumor was successfully resected without major complications and it was proven to be connected to the septum 1 cm above the mitral annulus. Pathological examination confirmed it to be a myxoma.