Ping-Pong Mitral Stenosis: Left Atrial Myxoma With Mitral St
Left atrial (LA) myxomas are the most common primary cardiac tumors and can have varied modes of presentation. Apart from embolic and systemic symptoms, they can mimic mitral stenosis when they obstruct the mitral valve. A high index of suspicion is required when they present in elderly males with symptoms of mitral valve obstruction.

Case Report
An 80-year-old male presented to us with symptoms of paroxysmal nocturnal dyspnea (PND), orthopnea, and palpitations for 3 months duration. Symptoms had particularly worsened after the onset of palpitations. He had no prior risk factors like diabetes, hypertension, ischemic heart disease, and hypo/hyperthyroidism. He also denied any constitutional symptoms like fever, weight loss, and arthralgia. On examination his pulse was irregular (100 beats/min), and blood pressure was 112/70 mm Hg. Cardiovascular examination revealed a variable first heart sound, mid diastolic murmur at the apex, no tumor plop, and loud pulmonary component of second heart sound. ECG showed atrial fibrillation. Chest X-ray revealed a straight left heart border with features of pulmonary venous hypertension. 2D echocardiogram (Fig. 1-3) showed a large homogenous pedunculated mass (4.7 × 3.2 cm) attached to interatrial septum obstructing the mitral valve in diastole (Supplementary video 1, There was moderate tricuspid regurgitation with a TR jet of 60 mm Hg indicating pulmonary hypertension (PHT). The patient underwent successful surgical excision of the mass (Fig. 4). Histopathology was consistent with myxoma....