Cardiac Myxoma in a Patient With Hypertrophic Cardiomyopathy
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This report discusses a rare case of concomitant hypertrophic cardiomyopathy and cardiac myxoma without LEOPARD syndrome. Additionally, 6 similar cases were systemically reviewed, and the characteristics of this first-ever studied patient group are summarized.

A 55-year-old male patient was referred to the authors’ Institute for Cardiomyopathies for evaluation due to thickened left ventricular walls detected by an external echocardiography examination. The patient’s ECG was positive for the Sokolow-Lyon index, and showed giant T-wave inversions and ST-segment depressions in the precordial leads. His blood test results revealed elevated concentrations of N-terminal pro–B-type natriuretic peptide (NT-proBNP) (1,165 ng/l) and high-sensitivity cardiac troponin T (hs-cTnT) (66 ng/l). A cardiac magnetic resonance (CMR) study was scheduled, because a potential cardiomyopathy was suspected.

The CMR results showed a notably hypertrophied left ventricle (maximal wall thickness of 26 mm) with an ejection fraction of 79% and diffuse positive late gadolinium enhancement (LGE) in the hypertrophied regions. The hypertrophy pattern indicated an apical type of HCM. In the in-house transthoracic echocardiogram, an additional broad-based mass attached to the interatrial septum was seen in the left atrium. Neither the gradient across the mitral valve (due to myxoma) nor the elevated left ventricular outflow tract (LVOT) gradient were present. The subsequent transesophageal echocardiogram revealed a friable multilobular tumor originating from the fossa ovalis (FO) in the left atrium, consistent with a myxoma. The heart catheterization results showed no evidence of coronary heart disease. Thus, the elevated hs-cTnT concentration was attributed to myocardial injury due to HCM. The elevated NT-proBNP concentration suggested heart failure.

This is the first study to systematically review the concomitance of cardiac myxoma and HCM without LEOPARD syndrome. Most of these patients were middle-aged males with HCM and myxoma in the left atrium. The underlying pathophysiological mechanisms require further investigation.