A 59-year-old female presented with a 1-week history of left arm pain. On clinical examination, the left hand was cold to palpation and had no radial or brachial pulses. Further workup with echocardiogram revealed a left atrial mass, likely a myxoma, and angiography of the left upper extremity revealed acute arterial occlusion of the left brachial artery (Figure 1). Myxoma resection on cardiopulmonary bypass and embolectomy of left brachial artery was planned.
In the operating room, intraoperative transesophageal echocardiography revealed a 1.9-cm by 3.9-cm left atrial mass attached to the lower interatrial septum (Figure 2). Cardiopulmonary bypass commenced after achieving adequate systemic heparinization. The left atrium was opened, and the mass was excised completely together with the stalk (Figures 3, 4).
Embolectomy of the left brachial artery was performed after the patient was successfully separated from cardiopulmonary bypass. The tumor embolus was removed completely (Figure 5), thereby restoring blood flow distally. The patient was taken to the intensive care unit in a stable condition and was successfully extubated 6 hours later. She recovered completely without neurological deficit.
There are two types of known cardiac myxoma: those with a firm and smooth surface and those with a gelatinous and irregular frond-like surface, with the latter more likely to embolize.1 Complete surgical excision of cardiac myxoma can be curative.