Left atrial myxoma: new perspectives in the diagnosis ofmurmur free cases

SUMMARY No cardiological signs or symptoms were seen in three patients with left atrial myxomas. The diagnosis was established by cross sectional echocardiography. In two patients this investigation was performed to exclude a cardiac source of systemic emboli. The third patient had constitutional signs only. All three had raised erythrocyte sedimentation rates and C reactive protein concentrations. In two patients the myxomas were successfully excised; the third patient who had presented with massive peripheral and central embolisation died during emergency operation. Cross sectional echocardiography is the technique of choice for detecting atrial myxomas and the absence of the cardiological signs should not preclude referral for diagnostic echo-cardiography. Left atrial myxoma is the most common primary cardiac tumour and is one of the few for which oper-ation offers a complete cure. Clinical findings are variable and non-specific and may mimic almost any other cardiovascular disorder. ` Before echo-cardiography became available, diagnosis of left atrial myxoma, if suspected, was made by angio-graphy or at necropsy or was an unexpected finding during cardiac operation. Cross sectional echo-cardiography has increased the number of myxomas that are diagnosed before operation.6-8 We report the clinical presentation, diagnosis, and management of three patients with left atrial myxoma seen over the past 12 months. These patients are representative of a wide spectrum of manifestations, the true cause of which may be missed when the myxoma does not produce a mur-mur. Patients and method