Left Atrial Myxoma with Secondary Tricuspid Regurgitation in A Peripheral Hospital: A Case Report and Literature Review

Abstract

Background: Cardiac myxoma, a rare disease of the heart, counts as the most common benign cardiac tumor. Around 75% arises in the left atrium. In peripheral hospital, where advanced imaging is often unavailable, diagnosis depends largely on clinical manifestation and transthoracal echocardiography.

Case Presentation: We present a 44-year-old female with progressive exertional shortness of breath for one month, palpitations, leg swelling, productive cough, and weakness. She had a history of an enlarged heart. Examination revealed tachycardia, a holosystolic murmur in the left lower sternal border, and bilateral pedal edema. Electrocardiography showed biatrial enlargements. Transthoracic echocardiography (TTE) demonstrated a left atrial mass sized 6.5 cm x 3.0 cm, severe tricuspid regurgitation, and left ventricle diastolic dysfunction. She was stabilized in our intensive care unit and subsequently referred to a higher-level hospital 30 hours later.

Discussion: In this patient, the myxoma swings into the mitral valve opening blocking blood flow from left atrium to left ventricle. This obstruction creates high pulmonary pressure, leading to right ventricular dilatation over time, which results in functional tricuspid regurgitation. Myxoma ideally requires prompt excision due to high risk of embolism and complete obstruction.

Conclusion: This case highlights the importance of careful physical examination and transthoracic echocardiography, as delayed diagnosis increases morbidity and mortality.