Akut ST elevasyonlu miyokard infarktüsü ve pulmoner ödem ile presente olan mitral kapakta atipik yerleşimli dev miksoma

Yıl 2018, , 41 - 43, 08.02.2018

Ertan Demirdaş , Kıvanç Atılgan , Zafer Cengiz Er Ferit Çiçekçioğlu

https://doi.org/10.28982/josam.379659

Öz

Kardiyak miksomalar %0,0017-0,03 insidansına sahip oldukça nadir olan bir hastalık olup en sık üçüncü ve altıncı dekadlar arasında görülür. Olguların %65’ini kadınlar oluşturur. Olguların %75’inde sol atriyumdan, %18’inde sağ atriyumdan, %4’ünde ise ventriküllerden köken alırlar. En nadir görüldükleri yer ise kapak dokuları olup sıklık sırası triküspit kapak, mitral kapak, pulmoner kapak ve aortik kapaktır. Kapak kökenli miksomaları gerçek insidansı belirsizdir. Klinik belirtileri sistemik semptomlar, emboliler ve intrakardiyak obstrüksiyonlardan kaynaklanır. Güçsüzlük, ateş, kilo kaybı, eklem ağrıları sistemik semptomlardan bazılarıdır. Tromboemboliler tümoral dokunun kendisinden kaynaklanabildiği gibi kitle üzerinde organize olmuş pıhtılardan da meydana gelebilmektedir. Dispne, ortopne, baş dönmesi, senkop ve pulmoner ödem intrakardiyak obstrüksiyonlardan kaynaklanan semptomlardır ve lokalizasyon, boyut ve hareketliliğe göre değişkenlik gösterebilir. Bu makalede dispne, göğüs ağrısı ve taşikardi ile prezente olan ve ST elevasyonlu miyokard enfarktüsü, akut pulmoner ödem, pulmoner hipertansiyon, paroksismal atriyal fibrilasyona yol açan mitral anuler ve posterior kapakçıktan köken alan dev miksoma tanısı alan 77 yaşında bir kadın hastayı sunmayı amaçladık. 

Anahtar Kelimeler

Miksoma, Mitral kapak, Akut koroner sendrom, Pulmoner ödem

Atypically mitral valve originated giant myxoma presenting with acute ST-segment elevation myocardial infarction and acute pulmonary edema

Öz

Cardiac myxoma is a rare disease with an incidence of 0.0017-0.03%, and most frequently are seen between the third and sixth decades. The 65% of cases are female. They originate from left atrium in 75% of the cases, from right atrium in 18% and from ventricles in 4%. The most rarely seen cardiac origins are valvular tissues and respectively origin from tricuspid valve, mitral valve, pulmonary valve and aortic valve. The exact incidence of myxomas originating from the mitral valve is not clear.  Clinical signs are classified in three groups such as systemic symptoms, symptoms related to thromboembolisms and symptoms related to intracardiac obstructions. Weakness, fever, weight loss, arthralgia are some of the systemic symptoms. Thromboembolisms are caused by either the tumoral tissue or the clot locating on the mass. Dyspnea, orthopnea, dizziness, syncope and pulmonary edema are examples of symptoms resulting from intracardiac obstructions, depending on the size, mobility and localization of the tumor. We aim to present a 77-year-old female presenting with dyspnea, angina pectoris and tachycardia and getting a diagnosis of a giant myxoma originating from the mitral annulus and posterior leaflet causing myocardial infarction with ST elevation, acute pulmonary edema, pulmonary hypertension, paroxysmal atrial fibrillation.

Anahtar Kelimeler

Myxoma, Mitral valve, Acute coronary syndrome, Pulmonary edema

Kaynakça

• 1. Centofanti P, Di RE, Deorsola L, Dato GM, Patane F, La TM, et al. Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Ann Thorac Surg. 1999;68:1236–1241.
• 2. Shapiro LM. Cardiac tumours: diagnosis and management. Heart. 2001;85:218–222.
• 3. Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 2001;21:439–449.
• 4. Patel J, Sheppard MN. Pathological study of primary cardiac and pericardial tumours in a specialist UK Centre: surgical and autopsy series. Cardiovasc Pathol. 2010;19:343–352.
• 5. Kuon E, Kreplin M, Weiss W, Dahm JB. The challenge presented by right atrial myxoma. Herz. 2004;29:702-709.
• 6. Murphy DP, Glazier DB, Krause TJ. Mitral valve myxoma. Ann Thorac Surg. 1997;64:1169-1170.
• 7. Chakfe N, Kretz JG, Valentin P, Geny B, Petit H et al. Clinical presentation and treatment options for mitral valve myxoma. Ann Thorac Surg. 1997;64:872-877.
• 8. Lehrman KL, Prozan GB, Ullyot D. Atrial myxoma presenting as acute myocardial infarction. Am Heart J. 1985;110:1293-1295.
• 9. Haffner PM, Neves VC, Lins G, Torres EM, Martins WA, Villacorta HJr, et al. Myocardial infarction and myxoma in the left atrium. Arq Bras Cardiol: Imagem Cardiovasc. 2013;26:315-319.
• 10. Sogabe O, Inokawa H, Tanaka S, Yamamoto H, Hashimoto K. Left atrial myxoma with a coronary artery steal syndrome due to the coronary artery to left atrial fistula; report of a case. Kyobu Geka. 2013;66(4):341-344.
• 11. Stiver K, Bittenbender P, Whitson BA, Bush CA. Left atrial myxoma causing coronary steal: an atypical cause of angina. Tex Heart Inst J. 2015;42(3):270-272.
• 12. Yoon JH, Kim JH, Sung YJ, Lee MH, Cha MJ, Kang DY, et al. Cardiac myxoma originating from the anterior mitral valve leaflet. J Cardiovasc Ultrasound. 2011;19(4):228–231.
• 13. Chen MY, Wang JH, Chao SF, Hsu YH, Wu DC et al. Cardiac myxoma originating from the anterior mitral leaflet. Jpn Heart J. 2003;44(3):429-434.
• 14. Ipek G, Erentug V, Bozbuga N, Polat A, Guler M, Kirali K, Peker O, Balkanay M, Akinci E, Alp M, Yakut C. Surgical management of cardiac myxoma. J Card Surg. 2005;20:300-304.
• 15. Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiacmyxoma. A series of 112 consecutive cases. Medicine (Baltimore). 2001;80:159-172.