Key result
Left atrial myxoma resection following acute ischemic stroke is complicated by cardiac tamponade.
Case Report (n=1)
This case highlights the importance of identifying atrial myxomas as a potential etiology for acute ischemic stroke and demonstrates that surgical resection can be curative despite potential post-operative complications.
May warrant myxoma evaluation in select cryptogenic stroke; leaves open prospective validation of embolic risk.
Introduction Left atrial myxomas are the most common primary cardiac tumors. 80% are located in the left atrium. They can obstruct blood flow, causing mitral regurgitation. They may also lead to thromboembolism and stroke. Case series have demonstrated a predominance towards women (60% to 70%) and a higher rate of thromboembolism with size less than 4.5cm. Case A 71-year-old female with tobacco use, family Hx of CVA, was hospitalized for left-sided weakness and numbness. A CT angiogram revealed right internal carotid artery stenosis and occlusion of the right V1 segment. An MRI showed additional acute infarcts in the inferior left cerebellar hemisphere. She was admitted to the Neurological ICU for neuro-monitoring. Etiology workup was ensued. An echocardiogram found a mass in the left atrium measuring 2.8 x 2.0 cm. 3D TEE was also performed. Concerned about atrial myxoma, cardiothoracic surgery was consulted, and the mass was surgically removed through sternotomy and atriotomy. She was admitted to the Cardiothoracic ICU post-operatively. Pathology confirmed it was an Atrial Myxoma. Her hospital course was complicated by cardiac tamponade from bleeding aortic access site that was repaired. She also developed atrial fibrillation, which was treated medically, and she was discharged from the hospital to recover from her stroke. Discussion Incidence of atrial myxoma is low, at 0.5 per 1000000 per year. Complications from thromboembolism can be severe. Mayo Clinic case series of 74 patients, about 12% had neurological issues related to atrial myxoma. Postoperative atrial arrhythmias are as common as 26% in one case series, and were also seen in this patient. ‘Association with Carney complex (cardiac tumors, skin pigmentation, endocrine tumors) with Autosomal Dominant inheritance due to PRKAR1A mutationGenetic testing indicated for suspected Carney complex (Young age with myxoma, recurrent myxoma, family hx of myxoma, skin pigmentation or endocrine tumors) This case highlights the need to identify atrial Myxomas a cause of strokes and ascertain family history to find association with Carney Complex. Surgical resection has been shown to be curative and associated with excellent long-term prognosis with a mortality rate under 5%. This abstract is funded by: None
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M Saludes (2026) conducted a case report in Atrial myxoma and acute ischemic stroke (n=1). Surgical resection was evaluated. Surgical resection of a 2.8 x 2.0 cm left atrial myxoma was performed in a 71-year-old female presenting with acute ischemic stroke, though her course was complicated by cardiac tamponade.
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