https://doi.org/10.4081/monaldi.2023.2768
Role of three-dimensional transesophageal echocardiography in cardiac myxomas: an imaging challenge
Submitted: September 3, 2023
Accepted: September 12, 2023
Published: September 19, 2023
Accepted: September 12, 2023
Abstract Views: 798
PDF_early view: 305
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Nowadays, the diagnosis of cardiac myxomas (CM), particularly the histological types, remains a challenge. Two-dimensional (2D) transthoracic (TT) and transesophageal (TEE) echocardiography (ECHO) represent the first steps in the imaging pathway. 3D ECHO, implemented in imaging practice, appears to be an emerging diagnostic technique that overcomes some of the limitations of 2D ECHO while integrating the information provided by magnetic resonance (MRI). However, its role in the imaging arena is still debatable. Analyzing 17 myxomas in 13 patients, the study uncovers a diverse anatomical spectrum. Classical CM morphology is a minority, with most myxomas being sessile and originating from unexpected locations (right ventricular outflow tract and left atrial appendage). Texture and size variations are also noted. Comparing imaging, 2D TEE outperforms 2D TT in visualizing anatomical features, especially attachment types. 3D TEE confirms 2D TT findings and offers more detailed assessments, identifying peduncles missed in four cases by 2D TEE. Two small recurrent myxomas were exclusively detected by 3D TEE, not by 2D TEE or MRI. Two patients have papillary myxomas, one has an embolism. Another patient with a solid myxoma also suffers an embolism, with a clot found at the apex during surgery. Our study showed that CM has a wide anatomical spectrum beyond the typical features, making the diagnosis challenging. Therefore, a multimodality imaging approach is essential for distinguishing CM from other cardiac masses and differentiating myxoma histological types. These findings stress the importance of incorporating 3D ECHO alongside other imaging techniques for a comprehensive evaluation.
Bjessmo S, Ivert T. Cardiac myxoma: 40 years’ experience in 63 patients. Ann Thorac Surg 1997;63:697-700.
DOI: https://doi.org/10.1016/S0003-4975(96)01368-9
Centofanti P, Di Rosa E, Deorsola L, et al. Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Ann Thorac Surg 1999;68:1236-41.
DOI: https://doi.org/10.1016/S0003-4975(99)00700-6
Poterucha TJ, Kochav J, O’Connor DS, Rosner GF. Cardiac tumors: clinical presentation, diagnosis and management. Curr Treat Opt Oncol 2019;20:66.
DOI: https://doi.org/10.1007/s11864-019-0662-1
Tyebally S, Chen D, Bhattacharyya S, et al. Cardiac tumors: JACC CardioOncology state-of-the-art review. JACC CardioOncol 2020;2:293-311.
DOI: https://doi.org/10.1016/j.jaccao.2020.05.009
El Sabbagh AD, Al-Hijji MA, Thaden JJ, et al. Cardiac myxoma: the great mimicker. JACC Cardiovasc Imaging 2017;10:203-6.
DOI: https://doi.org/10.1016/j.jcmg.2016.06.018
Kalçık M, Bayam E, Güner A, et al. Evaluation of the potential predictors of embolism in patients with left atrial myxoma. Echocardiography 2019;36:837-43.
DOI: https://doi.org/10.1111/echo.14331
Koritnik P, Pavsic N, Bervar M, Prokselj K. Echocardiographic characteristics of cardiac myxoma. Eur Heart J 2021;42:ehab724.0146.
DOI: https://doi.org/10.1093/eurheartj/ehab724.0146
Mankad R, Herrmann J. Cardiac tumors: echo assessment. Echo Res Pract 2016;3:R65-R77.
DOI: https://doi.org/10.1530/ERP-16-0035
Parato VM, Nocco S, Alunni G, et al. Imaging of cardiac masses: an updated overview. J Cardiovasc Echogr 2022;32:65-75.
DOI: https://doi.org/10.4103/jcecho.jcecho_18_22
Lang RM, Addetia K, Narang A, Mor-Avi V. 3-dimensional echocardiography: latest developments and future directions. JACC Cardiovasc Imaging 2018;11:1854-78.
DOI: https://doi.org/10.1016/j.jcmg.2018.06.024
Faletra FF, Agricola E, Flachskampf FA, et al. Three-dimensional transoesophageal echocardiography: how to use and when to use - a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2023;24:e119-e197.
DOI: https://doi.org/10.1093/ehjci/jead090
Galzerano D, Kinsara AJ, Di Michele S, et al. Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging? Int J Cardiovasc Imaging 2020;36:403-13.
DOI: https://doi.org/10.1007/s10554-019-01747-x
Khairnar P, Hsiung MC, Mishra S, et al. The ability of live three-dimensional transesophageal echocardiography to evaluate the attachment site of intracardiac tumors. Echocardiography 2011;28:1041-5.
Tolstrup K, Shiota T, Gurudevan S, et al. Left atrial myxomas: correlation of two-dimensional and live three-dimensional transesophageal echocardiography with the clinical and pathologic findings. J Am Soc Echocardiogr 2011;24:618-24.
DOI: https://doi.org/10.1016/j.echo.2011.01.007
Zaragoza-Macias E, Chen MA, Gill EA. Real time three-dimensional echocardiography evaluation of intracardiac masses. Echocardiography 2012;29:207-19.
DOI: https://doi.org/10.1111/j.1540-8175.2011.01627.x
Galzerano D, Pragliola C, Al Admawi M, et al. The role of 3D echocardiographic imaging in the differential diagnosis of an atypical left atrial myxoma. Monaldi for Chest Dis 2018;88:906.
DOI: https://doi.org/10.4081/monaldi.2018.906
Al Sergani R, Alamr B, Al Admawi M, et al. Three dimensional echocardiographic imaging of multiple recurrent myxomas. Monaldi for Chest Dis 2020;90:1188.
DOI: https://doi.org/10.4081/monaldi.2020.1188
Khairnar P1, Hsiung MC, Mishra S et al. The ability of live three-dimensional transesophageal echocardiography to evaluate the attachment site of intracardiac tumors. Echocardiography 2011;28:1041-5.
DOI: https://doi.org/10.1111/j.1540-8175.2011.01506.x
Espinola-Zavaleta N, Lozoya-Del Rosal JJ, Colin-Lizalde L, Lupi-Herrera E. Left atrial cardiac myxoma. Two unusual cases studied by 3D echocardiography. BMJ Case Rep 2014;2014:bcr2014205938.
DOI: https://doi.org/10.1136/bcr-2014-205938
Abbas A, Garfath-Cox KAG, Brown IW, et al. Cardiac MR assessment of cardiac myxomas Br J Radiol 2015; 88:1045.
DOI: https://doi.org/10.1259/bjr.20140599
Basso C, Buser PT, Rizzo S, et al. Benign cardiac tumors. In: V. Ferrari, Editor. EACVI Textbook of Cardiovascular Magnetic Resonance. Oxford, Oxford University Press; 2018. p. 469-73.
DOI: https://doi.org/10.1093/med/9780198779735.003.0041
Galzerano D, Eltayeb A, Alamri S, et al. A ping pong ball in the left ventricle. J Cardiothorac Vasc Anesth 2023;37:2153-6.
DOI: https://doi.org/10.1053/j.jvca.2023.06.002
Alamri F, Eltayeb A, Hamad A, et al. A native mitral valve mass beyond imagination. Monaldi Arch Chest Dis 2023. Online Ahead of Print.
DOI: https://doi.org/10.4081/monaldi.2023.2649
Pergola V, Al-Admawi M, Fadel B, Di Salvo G. An unusual cardiac mass: echocardiography, computed tomography, and magnetic resonance imaging. J Cardiol Cases 2016;13:143-5.
DOI: https://doi.org/10.1016/j.jccase.2016.01.002
How to Cite
Alamro, Bandar, Valeria Pergola, Abdalla Eltayeb, Amal Alshammari, Naji Kholaif, Ahmad Alhamshari, Mohammed Al Admawi, Shamayel Mohammed, Feras Khaliel, and Domenico Galzerano. 2023. “Role of Three-Dimensional Transesophageal Echocardiography in Cardiac Myxomas: An Imaging Challenge”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2023.2768.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Sotirios D. Moraitis, Apostolos C. Agrafiotis, Dimitrios Pappas, Chrysovalantis Pothitakis, Maria Stergianni, Ioannis Koukis, Thymic pathology and cardiac myxomas: Coincidence or a closer relationship? , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Domenico Galzerano, Claudio Pragliola, Mohamed Al Admawi, Mario Mallardo, Sara Di Michele, Carlo Gaudio, The role of 3D echocardiographic imaging in the differential diagnosis of an atypical left atrial myxoma , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Roberto F.E. Pedretti, Francesco Fattirolli, Raffaele Griffo, Marco Ambrosetti, Elisabetta Angelino, Silvia Brazzo, Ugo Corrà , Nicolò Dasseni, Pompilio Faggiano, Giuseppe Favretto, Oreste Febo, Marina Ferrari, Francesco Giallauria, Cesare Greco, Manuela Iannucci, Maria Teresa La Rovere, Mario Mallardo, Antonio Mazza, Massimo Piepoli, Carmine Riccio, Simonetta Scalvini, Luigi Tavazzi, Pier Luigi Temporelli, Gian Francesco Mureddu, Cardiac Prevention and Rehabilitation “3.0â€: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Concezione Tommasino, Cardiovascular risk assessment in the senior population undergoing anesthesia for non-cardiac surgery , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Floriana Caccamo, Simone Saltini, Enrico Carella, Roberto Carlon, Cristina Marogna, Vito Sava, The measure of effectiveness of a short-term 2-week intensive Cardiac Rehabilitation program in decreasing levels of anxiety and depression , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Rodolfo Citro, Antonello Panza, Paolo Masiello, Amelia Ravera, Lucia Tedesco, Rocco Leone, Marco Mirra, Roberta Giudice, Severino Iesu, Francesco Silvestri, Giuseppe Di Benedetto, Eduardo Bossone, Intramural aortic hematoma: no flap no warning? , Monaldi Archives for Chest Disease: Vol. 76 No. 1 (2011): Cardiac series
- Francesco Giallauria, Rosa Lucci, Francesco Pilerci, Anna De Lorenzo, Athanasio Manakos, Marianna Psaroudaki, Mariantonietta D’Agostino, Alessandra Vitelli, Luigi Maresca, Domenico Del Forno, Carlo Vigorito, Efficacy of Telecardiology in improving the results of Cardiac Rehabilitation after acute myocardial infarction , Monaldi Archives for Chest Disease: Vol. 66 No. 1 (2006): Cardiac series
- Elio Gorga, Marta Scodro, Francesca Valentini, Renzo D'Ortona, Mariachiara Arisi, Edoardo Sciatti, Ivano Bonadei, Valentina Regazzoni, Enrico Vizzardi, Marco Metra, Piergiacomo Calzavara Pinton, Echocardiographic evaluation of diastolic dysfunction in young and healthy patients with psoriasis: A case-control study , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Raffaele Griffo, Francesco Fattirolli, Pier Luigi Temporelli, Roberto Tramarin, Italian survey on CArdiac RehabilitatiOn and Secondary prevention after cardiac revascularization: ICAROS study. A survey from the italian cardiac rehabilitation network: rationale and design , Monaldi Archives for Chest Disease: Vol. 70 No. 3 (2008): Cardiac series
- Achille Pulcino, Chiara Sordelli, Gennaro Ismeno, Francesco Paolo Tritto, Paolo Golino, Luigi Piazza, A case of quadricuspid aortic valve characterized by echocardiography and magnetic resonance imaging , Monaldi Archives for Chest Disease: Vol. 76 No. 3 (2011): Cardiac series
You may also start an advanced similarity search for this article.
