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Coronary artery–left atrial fistula caused by feeding artery rupture in cardiac myxoma
  1. K Zen,
  2. T Asai,
  3. H Tatsukawa,
  4. H Matsubara
  1. k-zen{at}

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An 81-year-old woman with atrial fibrillation and a history of amaurosis fugax was admitted to our hospital for diagnosis and therapy. Her vital signs and laboratory data were normal on admission. No fresh ischaemic lesions in the brain or organic stenosis of the head and neck arteries were observed on a magnetic resonance imaging scan. Although transthoracic echocardiography did not show any thrombus in the cardiac chambers, a cardiac tumour (5 × 4 cm) was detected in the left atrium (LA). Multiplane transoesophageal echocardiography (TOE) interpreted it as a multilocular tumour with heterogeneous echodensity; the tumour was attached to the interatrial septum. These findings were suggestive of myxoma (panel A). Colour Doppler images showed an intratumour blood flow and blood stream spurting from the tumour (arrow in panel B and video 1; to view video footage visit the Heart website— Conventional coronary angiography (CAG) revealed the presence of a feeding artery from the proximal portion of the left circumflex branch to the LA. The tumour was remarkably enhanced, like a bunch of grapes, by the contrast media, which spouted out into the LA (video 2), as well as by the TOE images. At surgery, the diagnosis of left atrial myxoma was made. The internal elastic lamina of the artery near the tumour stalk was partially destroyed, and it was associated with fibrous thrombus; this indicated artery rupture. This must have been the cause of the coronary artery–left atrial fistula through the myxoma, which was observed by TOE and CAG; however, its causal relationship with the history of amaurosis fugax was not clear.

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(A): Multiplane transoesophageal echocardiography showing a multilocular cardiac tumour attached to the interatrial septum in the left atrium, with heterogeneous echodensity. (B): Colour Doppler images showing an intratumour blood flow and blood stream (arrow) spurting from the tumour.