title: Atrial Myxoma Presenting as Myocardial Infarction Diagnosed by Echocardiography, Managed Endoscopically with Robot-Assisted Surgery.
abstract: Atrial myxomatous embolization into the coronary arteries is a rare event. Management of large myxomas is usually via surgical resection involving a median sternotomy. Echocardiography is not a routine part of non-ST-elevation myocardial infarction (NSTEMI) management. Here, we present the case of a 70-year-old Caucasian man with a history of hypertension and hyperlipidemia who presented to the emergency department with an NSTEMI. Transthoracic echocardiogram and transesophageal echocardiogram revealed a large and highly mobile atrial mass, traversing through the mitral valve orifice during diastole. Coronary angiography revealed a focal 60% lesion in the right coronary artery and no other significant obstructive coronary artery disease, suggesting that the cause of his presentation was tumor embolization into the coronary circulation. The patient underwent robot-assisted endoscopic resection of his atrial mass and was discharged in stable condition on postoperative day 2. Pathology revealed atrial myxoma. To our knowledge, this is the first reported case of an atrial myxoma presenting with an NSTEMI and managed with a robot-assisted endoscopic approach. This case also highlights the importance of routine early echocardiography in patients presenting with NSTEMI.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine.
authors.forename: Aadel A
authors.initials: AA
authors.lastname: Chaudhuri
authors.affiliation: Emergency Medicine, Scripps Mercy Hospital.
authors.forename: Charles
authors.initials: C
authors.lastname: Simmons
authors.affiliation: Pathology, Scripps Mercy Hospital.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ellison
authors.affiliation: Cardiothoracic Surgery, Scripps Mercy Hospital.
authors.forename: James
authors.initials: J
authors.lastname: Hemp
authors.affiliation: Cardiology, Scripps Mercy Hospital.
authors.forename: Kiyon
authors.initials: K
authors.lastname: Chung
keywords: atrial myxoma; echocardiography; endoscopic surgery; myocardial infarction; non-st elevation myocardial infarction; nstemi; robotic surgery