Jayadevappa Ganesh, Chaudhri Babar
Department of Anaesthesiology, Aster Hospitals, Dubai, ARE.
Department of Cardiac Surgery, Aster Hospitals, Dubai, ARE.
Cureus. 2025 Mar 3;17(3):e79978. doi: 10.7759/cureus.79978. eCollection 2025 Mar.
Left atrial myxomas are the most common primary cardiac tumors, often presenting with symptoms related to obstruction, embolization, or systemic effects. Thrombocytopenia is an uncommon but significant complication associated with myxomas, complicating their management. In this case, a 26-year-old male presented with severe dyspnea, palpitations, and blurred vision. Clinical examination revealed a mid-diastolic crescendo murmur, hepatomegaly, and elevated jugular venous pressure. Investigations showed thrombocytopenia, which is very significant in the perioperative management of this case, requiring specific treatment and precautions to be taken. The other factors, such as elevated liver enzymes and significant mitral valve obstruction caused by a left atrial mass, were also noted. Echocardiography and CT imaging confirmed the diagnosis of left atrial myxoma causing mitral valve inflow obstruction and hepatic congestion secondary to right heart failure. A multidisciplinary team managed the patient, and emergency surgery was performed to excise the tumor and repair the mitral and tricuspid valves with intraoperative transesophageal echocardiographic assistance. Postoperative management included monitoring in the intensive care unit, platelet transfusion, and supportive care, leading to a steady recovery. The patient was discharged on day 10 with stable platelet levels and total left atrial mass removal, which improved cardiac function. Histopathology confirmed the diagnosis of cardiac myxoma. This case highlights the diverse clinical manifestations of left atrial myxomas and the need for prompt diagnosis and multidisciplinary management, especially when complicated by thrombocytopenia and hepatic congestion. Surgical excision remains the treatment of choice, with favorable outcomes following complete tumor removal and valve repair.
左心房黏液瘤是最常见的原发性心脏肿瘤，常表现出与梗阻、栓塞或全身影响相关的症状。血小板减少症是与黏液瘤相关的一种罕见但严重的并发症，会使治疗变得复杂。在本病例中，一名26岁男性出现严重呼吸困难、心悸和视力模糊。临床检查发现舒张中期递增型杂音、肝肿大和颈静脉压升高。检查显示血小板减少，这在该病例的围手术期管理中非常重要，需要采取特定的治疗和预防措施。还注意到了其他因素，如肝酶升高以及左心房肿物导致的严重二尖瓣梗阻。超声心动图和CT成像确诊为左心房黏液瘤，导致二尖瓣血流梗阻以及继发于右心衰竭的肝淤血。一个多学科团队对该患者进行了治疗，并在术中经食管超声心动图辅助下进行了紧急手术，切除肿瘤并修复二尖瓣和三尖瓣。术后管理包括在重症监护病房进行监测、输注血小板和支持治疗，患者病情稳步恢复。患者于第10天出院，血小板水平稳定，左心房肿物完全切除，心脏功能得到改善。组织病理学确诊为心脏黏液瘤。该病例突出了左心房黏液瘤多样的临床表现，以及及时诊断和多学科管理的必要性，尤其是在合并血小板减少症和肝淤血时。手术切除仍然是首选治疗方法，肿瘤完全切除和瓣膜修复后预后良好。
