Calcified Left Atrial Myxoma Simulating Mitral Insufficiency

In the atypical case presented, a calcified myxoma of the left atrium simulated isolated mitral insufficiency. Unique hemodynamic and phonocardiographic events were recorded. A notch in the upstroke of the left ventricular pressure tracing during isometric contraction occurred simultaneously with an ejection sound, which fused with the first heart sound, and with an abrupt decrease in ventricular volume as the tumor was ejected from the ventricle. A similar notch in the downstroke of the ventricular pressure tracing was most likely due to the abrupt increase in ventricular volume as the tumor descended into the left ventricle. A third heart sound was present which was identified as a ventricular diastolic gallop and was differentiated from a mitral opening snap by simultaneous pressure tracings.