Cardiac myxoma: a rare cause of acute myocardial infarction

Bu çalışmada kardiyak miksomaya bağlı akut miyokard enfarktüsünün klinik özellikleri araştırıldı.Çalışma planı: Çalışmanın veri kaynağı 01 Ocak 1990 ve 31 Ağustos 2014 tarihleri arasındaki İngilizce literatürden kapsamlı bir veri edinimine dayandırıldı. Kardiyak miksomaya bağlı akut miyokard enfarktüsü olan toplam 48 hasta (ort. yaş 45.2±15.3 yıl; dağılım 9-70 yıl) çalışmaya dahil edildi.Bul gu lar: En yaygın başlangıç semptomu, hastaların %75.6'sında görülen göğüs ağrısı ile akut başlangıç idi. Hastaların çoğunda serum miyokard enzimlerinin düzeyi yüksekti. Anterior miyokard enfarktüsünü takiben inferior miyokard enfarktüs en yaygın olandı. Yirmi hastada (%48.8) normal bir koroner arter, 21 hastada (%51.2) koroner tıkayıcı lezyon bulunurken yedi hastada koroner koşullar belirtilmemişti. Kardiyak miksoma tanısı hastaların %83.7'sinde sadece transtorasik ekokardiyografi ile konuldu ve kardiyak miksomaların %93.3'ü sol atriyumda idi. On yedi hastada (%35.4) trombolitik veya antikoagülan tedavileri içeren konservatif tedavi tanımlandı. İki hastada cerrahi tedavi fırsatı olmaksızın ani ölüm gelişti. Kırk dört hastada (%95.7) miksoma için cerrahi rezeksiyon uygulandı. Perkütan koroner girişim iki hastada (%40) başarısız oldu. Sonuç olarak, 38 (%88.4) olaysız sağkalım, üç (%7.0) engellilikli sağkalım ve iki (%4.7) ölüm vardı.So nuç: Koroner arter hastalığın belirgin risk faktörleri olmayan genç akut miyokard enfarktüslü hastalarda miksoma ilişkili akut miyokard enfarktüsü dikkate alınmalıdır ve konvansiyonel koroner arter hastalığın ayırıcı tanısı için ekokardiyografik görüntüleme gereklidir. Koroner embolinin durumunu tanımlamak ve ileri tedaviye karar vermek için koroner anjiyogram çok önemlidir. İlişkili periferik embolik olaylar sıklıkla embolektomi gerektirir

Kardiyak miksoma: Akut miyokard enfarktüsünün nadir bir nedeni

This study aims to investigate the clinical features of acute myocardial infarction secondary to cardiac myxoma.Methods: Data source of the study was based on a comprehensive retrieval of the English literature between the dates January 1st 1990 and August 31st 2014. A total of 48 patients (mean age 45.2±15.3 years; range 9 to 70 years) with acute myocardial infarction secondary to cardiac myxoma were included in the study.Results: Most patients had an acute onset with chest pain being the prevailing onset symptom accounting for 75.6%. Majority of the patients had elevated serum myocardial enzyme levels. Inferior myocardial infarction was the most frequent followed by anterior myocardial infarction. A normal coronary artery was found in 20 patients (48.8%), coronary occlusive lesion in 21 patients (51.2%), while coronary conditions were not given in seven patients. Cardiac myxoma was diagnosed solely by transthoracic echocardiography in 83.7% of the patients and 93.3% of the cardiac myxomas were in the left atrium. Conservative management including thrombolytic and/or anticoagulant therapies was described in 17 patients (35.4%). Two patients had sudden death without an opportunity for surgical treatment. A surgical resection of the myxoma was performed in 44 patients (95.7%). Percutaneous coronary intervention failed in two patients (40%). As a result, there were 38 (88.4%) event-free survivals, three (7.0%) survivals with disabilities, and two (4.7%) deaths.Conclusion: In young patients with acute myocardial infarction without apparent risk factors of coronary artery disease, a myxoma-related acute myocardial infarction should be considered and an echocardiographic screening is necessary for a differential diagnosis with conventional coronary artery disease. Coronary angiogram is crucial in identifying the status of coronary emboli and for decision-making for further management. Associated peripheral embolic events frequently warrant an embolectomy

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