Myxoma of the Left Auricle With Direct Pressure Tracings

From the General Infirmary at Leeds Cardiac myxoma has been reported with increasing frequency in recent years.Pritchard (1951) reviewed some 200 cases then reported.At least twenty-eight further examples have been pub- lished in Great Britain and the United States of America; of these nineteen were in women and two-thirds of them died between the ages of thirty and sixty years.Straus and Merliss (1945) attempted to estimate the true incidence by comparing the statistics of the American Medical Association for the number of autopsies performed in the United States of America with the number of cases of primary cardiac tumour reported in the same five-year period, 1938-42.The autopsies numbered 480,331 and 8 cases of primary cardiac tumour were found, giving an estimate of 17 per million.This may be regarded as a minimum figure and is equivalent to about 10 patients per annum in Great Britain.We report a case that exhibited most of the characteristic clinical features.Few of the published accounts have included intra-cardiac pressure measurements, and none has been found in which, as in this instance, direct measurement of the left auricular pressure was made by means of a needle passed through the left bronchus. Case ReportThe patient, a Jew, was aged 45.He was first admitted to the General Infirmary at Leeds in April, 1951, with a vague history of intermittent dizziness of several months duration, followed by the sudden onset of right frontal headache and impaired vision three days previously.There was no history of rheumatic fever and no cardiac symptoms were present, but an apical presystolic murmur was queried.The blood pressure was 120/80.He was found to have a homonymous, roughly quadrantic defect of the upper left visual field which afterwards persisted.Effort dyspncea began early in 1954 and in June of that year there were two episodes of sudden dyspncea followed by cough and white frothy sputum.He was examined then and found to have pre- systolic and systolic murmurs at the apex.He had sinus rhythm, a blood pressure of 120/85, and fine rales at both bases but no cedema.He was admitted to hospital for a month and improved readily on routine treatment.At that time fluoroscopy showed considerable left auricular enlargement with some right ventricular hypertrophy and pulmonary congestion, and the X-ray examination was considered to be in keeping with the diagnosis of mitral stenosis.The electrocardiogram showed sinus rhythm and right axis deviation only.From this time dyspncea became progressively worse.CEdema appeared in July, 1955, and increased steadily.In that month he lost consciousness suddenly when sitting in a chair, fell to the floor, and was unconscious for a quarter of an hour.A similar but very short loss of consciousness occurred in December, 1955.He was admitted to the Herzl Moser Hospital at Leeds in November, 1955, for treatment of con- gestive heart failure, and discharged nine weeks later somewhat improved, but still in failure.In January, 1956, he was admitted to the General Infirmary at Leeds for further investigation and possible valvotomy.The physical examination showed sinus rhythm with multiple extrasystoles and a blood pressure of 115/70.The apex was in the fifth space in the anterior axillary line with a tapping cardiac impulse.The first sound was accentuated at the apex and a third sound was present in early diastole.There was a moderate, grade 3, apical systolic murmur and soft rumbling mid-diastolic and presystolic 575 on August 15,