Perioperative Management of Left Atrial Myxoma Causing Mitral Valve Obstruction and Thrombocytopenia: A Case Report.

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.