A comorbidity of cardiac atherosclerotic disease with cardiac myxomas being concomitantly treated by coronary artery bypass grafting coupling with tumor resection: a case report

Introduction and importance: Cardiac atherosclerotic disease (CAD), the leading cause to cardiovascular disease-related death, coexisting with cardiac myxoma, the commonest benign primary cardiac neoplasm, is rare. The treatment of the comorbidity is complicated due to the rarity and inexperience. Case presentation: A 65-year old male patient with intermittent chest tightness and shortness of breath for 10 years was admitted for further work-up. On admission, the comprehensive metabolic panel (CMP) revealed a normal liver, kidney and coagulant function, and the BNP, troponin and CK-MB were within the normal limits. ECG showed a sinus rhythm. Cardiac catheterization revealed a three-vessel disease of CAD. Incidentally, echocardiography and MRI found a mobile mass, highly suspicious of cardiac myxomas on the imaging, at the left atrium. A coronary artery bypass grafting (CABG) combining with a right-atrium approach resection of the lesion were devised and concomitantly performed. No surgical complications and major cardiac adverse events occurred post-procedure. After anti-infection and supportive care, the patient recovered uneventfully. Follow-up at 6 months revealed no discomfort of the patient. Clinical discussion: It was risky to treat the comorbidity separately. Due to the rarity of the comorbidity, it remains unsolved whether the prognosis will be truly affected by the concurrent procedures. Yet, this single case with a prosperous outcome post-surgery might provide a valuable reference to the treatment of cardiac myxomas incidentally diagnosed in CAD. Conclusion: The three-vessel CAD co-occurring with the single lesion cardiac myxomas at the left atrium can be managed safely and effectively by combining CABG with transseptal right atriotomy in the concomitant procedures.