Chaudhuri Aadel A, Simmons Charles, Ellison Douglas, Hemp James, Chung Kiyon
Department of Radiation Oncology, Stanford University School of Medicine.
Emergency Medicine, Scripps Mercy Hospital.
Cureus. 2016 Feb 7;8(2):e484. doi: 10.7759/cureus.484.
Atrial myxomatous embolization into the coronary arteries is a rare event. Management of large myxomas is usually via surgical resection involving a median sternotomy. Echocardiography is not a routine part of non-ST-elevation myocardial infarction (NSTEMI) management. Here, we present the case of a 70-year-old Caucasian man with a history of hypertension and hyperlipidemia who presented to the emergency department with an NSTEMI. Transthoracic echocardiogram and transesophageal echocardiogram revealed a large and highly mobile atrial mass, traversing through the mitral valve orifice during diastole. Coronary angiography revealed a focal 60% lesion in the right coronary artery and no other significant obstructive coronary artery disease, suggesting that the cause of his presentation was tumor embolization into the coronary circulation. The patient underwent robot-assisted endoscopic resection of his atrial mass and was discharged in stable condition on postoperative day 2. Pathology revealed atrial myxoma. To our knowledge, this is the first reported case of an atrial myxoma presenting with an NSTEMI and managed with a robot-assisted endoscopic approach. This case also highlights the importance of routine early echocardiography in patients presenting with NSTEMI.
心房黏液瘤栓塞入冠状动脉是一种罕见事件。大型黏液瘤的治疗通常通过正中开胸手术切除。超声心动图并非非ST段抬高型心肌梗死（NSTEMI）管理的常规组成部分。在此，我们报告一例70岁白种男性病例，该患者有高血压和高脂血症病史，因NSTEMI就诊于急诊科。经胸超声心动图和经食管超声心动图显示一个大型且活动度高的心房肿物，舒张期穿过二尖瓣口。冠状动脉造影显示右冠状动脉有一处60%的局灶性病变，无其他显著的阻塞性冠状动脉疾病，提示其就诊原因是肿瘤栓塞入冠状动脉循环。患者接受了机器人辅助内镜下切除心房肿物，术后第2天病情稳定出院。病理检查显示为心房黏液瘤。据我们所知，这是首例报道的以NSTEMI表现并采用机器人辅助内镜方法治疗的心房黏液瘤病例。该病例还凸显了对NSTEMI患者进行常规早期超声心动图检查的重要性。
