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Cardiac Myxoma Post-Transseptal Ablation: Coincidence or Causation?

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Background: Cardiac myxomas are benign cardiac neoplasms usually found solitarily located within a single cardiac chamber, most commonly in the left atrium. With no established cause, they are often thought to occur spontaneously with no particular genetic cause or external incitement. While it has been explored, there is no universally accepted correlation with myxoma formation following a cardiac ablation procedure. We propose the theory of an iatrogenic causation of cardiac myxoma formation, likely incited by the local tissue injury during the transseptal puncture of the interatrial wall. Case Summary: We present the case of a 62-year-old male with a medical history significant for Atrial Fibrillation for which he underwent a transseptal ablation procedure, during which a puncture is made through the interatrial septum. Transthoracic and transesophageal echocardiograms obtained prior to the procedure did not reveal any intracardiac masses or abnormalities. Two-years post-procedure, during an inpatient hospitalization for a suspected asthma exacerbation, a new transthoracic echocardiogram demonstrated a pedunculated mass within the left atrium. 1. Rubio Alvarez J, Martinez de Alegria A, Sierra Quiroga J, Adrio Nazar B, Rubio Taboada C, Martinez Comendador JM. Rapid growth of left atrial myxoma after radiofrequency ablation. Tex Heart Inst J. 2013;40(4):459-61. PMID: 24082379; PMCID: PMC3783123. 2. Wada et al. General Thoracic and Cardiovascular Surgery Cases https://doi.org/10.1186/s44215-024-00145-7 3. Santillo E, Migale M, Marini L, Fallavollita L, Massini C, Balestrini F. Left atrial myxoma development after radiofrequency ablation of an atrial flutter substrate. JC Cases. 2015;11:124-6. 4. Kahraman, D. Et. Al. Refractory anemia and myxoma after radiofrequency ablation: a case report. Cardiovasc Surg Int 2016;3(1):15-17 http://dx.doi.org/DOI: 10.5606/e-cvsi.2016.479 5. Islam, AKMM. Cardiac Myxomas: A narrative Review. World J Cardiol 2022 April 26; 14(4): 206-219. 10.4330/wjc.v14.14.206 6. Satomi, K. Editorial: Incidental tumor or ablation-promoted oncogenesis? Journal of Cardiology Cases. 12 (2015) 30-31. http://dx.doi.org/10.1016/j.jccase.2015.04.001 7. AlAhmadi HH, Alsafwani NS, Shawarby MA, Ahmed F. Cardiac Myxoma: Typical Presentation but Unusual Histology. Case Rep Med. 2021 May 4;2021:6611579. doi: 10.1155/2021/6611579. PMID: 34035819; PMCID: PMC8116158. 8. Lee VH, Connolly HM, Brown RD. Central Nervous System Manifestations of Cardiac Myxoma. Arch Neurol.2007;64(8):1115–1120. doi:10.1001/archneur.64.8.1115 9. Okongwu CC, Olaofe OO. Cardiac myxoma: a comprehensive review. J Cardiothorac Surg. 2025 Mar 13;20(1):151. doi: 10.1186/s13019-024-03333-2. PMID: 40082903; PMCID: PMC11905437. 10. El Sabbagh, A, Al-Hijji, M, Thaden, J. et al. Cardiac Myxoma: The Great Mimicker. J Am Coll Cardiol Img. 2017 Feb, 10 (2) 203–206. https://doi.org/10.1016/j.jcmg.2016.06.018 11. I.M. Keeling, P. Oberwalder, M. Anelli-Monti, H. Schuchlenz, U. Demel, G.P. Tilz, P. Rehak, B. Rigler, Cardiac myxomas: 24 years of experience in 49 patients, European Journal of Cardio-Thoracic Surgery, Volume 22, Issue 6, December 2002, Pages 971–977, https://doi.org/10.1016/S1010-7940(02)00592-4 12. Ngow HA, Khairina WM. Atrial myxoma: histological confirmation. Heart Asia. 2011 Jan 1;3(1):43-4. doi: 10.1136/ha.2010.003046. PMID: 27325987; PMCID: PMC4898555. 13. Hamdan, M., Alam, B. & Kossaify, A. A polo ball in the right atrium, importance of echocardiographic characteristics of intracardiac myxomas: a case report. J Med Case Reports 17, 403 (2023). https://doi.org/10.1186/s13256-023-04130-6. 14. Wang JG, Li YJ, Liu H, Li NN, Zhao J, Xing XM. Clinicopathologic analysis of cardiac myxomas: Seven years experience with 61 patients. J Thorac Dis 2012;4 (3):272-283. DOI: 10.3978/j.issn.2072-1439.2012.05.07. 15. Zahra, K, Salma, S, Ali, T. et al. Giant Right Atrial Myxoma: Multimodality Imaging and Management. J Am Coll Cardiol Case Rep. 2025 Jan, 30 (2) https://doi.org/10.1016/j.jaccas.2024.102772. 16. Cotrim, N, Veiga, A, Castilho, B. et al. Giant Cardiac Myxoma as a Cause of Stroke. J Am Coll Cardiol Case Rep. 2024 Dec, 29 (24). https://doi.org/10.1016/j.jaccas.2024.102866. 17. Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, AnastasiouNana M. Cardiac tumors. ISRN Oncol. 2011;2011:208929. doi: 10.5402/2011/208929. Epub 2011 May 26. PMID: 22091416; PMCID: PMC3195386. 18. Nektaria M, Theologou S, Christos C, George S, Rokeia E, Dimitrios S, Ioanna P. Cardiac myxomas: A single-center case series of 145 patients over a 32-year period study. Ann Card Anaesth. 2023 Jan-Mar;26(1):17-22. doi: 10.4103/aca.aca_290_20. PMID: 36722583; PMCID: PMC9997480. 19. Sido V, Volkwein A, Hartrumpf M, Braun C, Kühnel RU, Ostovar R, Schröter F, Chopsonidou S, Albes JM. Gender-Related Outcomes after Surgical Resection and Level of Satisfaction in Patients with Left Atrial Tumors. J Clin Med. 2023 Mar 6;12(5):2075. doi: 10.3390/jcm12052075. PMID: 36902863; PMCID: PMC10003994. 20. Lima NA, Byers-Spencer K, Cwikla K, Huffman C, Diaz M, Melgar TA, Helmstetter N. Benign Cardiac Neoplasms in the United States: A Thirteen-Year Review. Cardiology. 2021;146(6):748-753. doi: 10.1159/000519290. Epub 2021 Sep 1. PMID: 34469887; PMCID: PMC8743935. 21. Saleh Y, Hammad B, Almaghraby A, Abdelkarim O, Seleem M, Abdelnaby M, Shehata H, Hammad M, Ramadan B, Elshafei M, Elsharkawy E, Abdel-Hay MA. Carney Complex: A Rare Case of Multicentric Cardiac Myxoma Associated with Endocrinopathy. Case Rep Cardiol. 2018 Jul 2;2018:2959041. doi: 10.1155/2018/2959041. PMID: 30065853; PMCID: PMC6051319. 22. Amano J, Kono T, Wada Y, Zhang T, Koide N, Fujimori M, Ito K. Cardiac myxoma: its origin and tumor characteristics. Ann Thorac Cardiovasc Surg. 2003 Aug;9(4):215-21. PMID: 13129418. 23. Orlandi A, Ciucci A, Ferlosio A et al (2006) Cardiac myxoma cells exhibit embryonic endocardial stem cell features. J Pathol 209(2):231-239. https://doi.org/10.1002/path.1959. 24. Sakamoto H, Sakamaki T, Sumino H, Sawada Y, Sato H, Sato M, Fujita K, Kanda T, Tamura J, Kurabayashi M. Production of endothelin-1 and big endothelin-1 by human cardiac myxoma cells- -implications of the origin of myxomas--. Circ J. 2004 Dec;68(12):1230-2. doi: 10.1253/circj.68.1230. PMID: 15564714. 25. Singhal P, Luk A, Rao V, Butany J (2014) Molecular basis of cardiac myxomas. Int J Mol Sci 15(1):1315–1337. https://doi.org/10.3390/ijms15011315. 26. Sughimoto K., Shiikawa A., Ohkado A., Nanaumi M. Multiple cardiac myxomas with pulmonary artery obstruction and acute right heart failure. Jpn. J. Thorac. Cardiovasc. Surg. 2004;52:530–533. doi: 10.1007/s11748-004-0005-3. 27. Mendyka D, Płonek T, Jędrasek T, Korman A, Złotowska A, Jędrasek A, Skalik R, Kustrzycki W. The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review. J Clin Med. 2024 Dec 28;14(1):121. doi: 10.3390/jcm14010121. PMID: 39797207; PMCID: PMC11722112. 28. Changing management of cardiac myxoma based on a series of 40 cases with long-term follow-up Selkane, Chekir et al. The Annals of Thoracic Surgery, Volume 76, Issue 6, 1935 – 1938. 29. Argueta EE, Ratheal K, Prieto S, Paone R, Jenkins LA, Oyenuga O. Recurrent atrial myxoma, right atriotomy, and sinus node dysfunction: a case of interdisciplinary care. The Southwest Respiratory and Critical Care Chronicles 2018;6(23):42–46. 30. Scalise M, Torella M, Marino F, Ravo M, Giurato G, Vicinanza C, Cianflone E, Mancuso T, Aquila I, Salerno L, Nassa G, Agosti V, De Angelis A, Urbanek K, Berrino L, Veltri P, Paolino D, Mastroroberto P, De Feo M, Viglietto G, Weisz A, Nadal-Ginard B, Ellison-Hughes GM, Torella D. Atrial myxomas arise from multipotent cardiac stem cells. Eur Heart J. 2020 Dec 1;41(45):4332-4345. doi: 10.1093/eurheartj/ehaa156. PMID: 32330934; PMCID: PMC7735815.
Boston Science Publishing
Resha Reya Ganthan MD Ezra Schrem MD Asher Gorantla MD Nidal Isber MD FACC FHRS Gautham Upadhya MD FACC Francesco Rotatori MD FACC
World Journal of Case Reports and Clinical Images
2025
Title: Cardiac Myxoma Post-Transseptal Ablation: Coincidence or Causation?
Description:
Background: Cardiac myxomas are benign cardiac neoplasms usually found solitarily located within a single cardiac chamber, most commonly in the left atrium.
With no established cause, they are often thought to occur spontaneously with no particular genetic cause or external incitement.
While it has been explored, there is no universally accepted correlation with myxoma formation following a cardiac ablation procedure.
We propose the theory of an iatrogenic causation of cardiac myxoma formation, likely incited by the local tissue injury during the transseptal puncture of the interatrial wall.
Case Summary: We present the case of a 62-year-old male with a medical history significant for Atrial Fibrillation for which he underwent a transseptal ablation procedure, during which a puncture is made through the interatrial septum.
Transthoracic and transesophageal echocardiograms obtained prior to the procedure did not reveal any intracardiac masses or abnormalities.
Two-years post-procedure, during an inpatient hospitalization for a suspected asthma exacerbation, a new transthoracic echocardiogram demonstrated a pedunculated mass within the left atrium.
1.
Rubio Alvarez J, Martinez de Alegria A, Sierra Quiroga J, Adrio Nazar B, Rubio Taboada C, Martinez Comendador JM.
Rapid growth of left atrial myxoma after radiofrequency ablation.
Tex Heart Inst J.
2013;40(4):459-61.
PMID: 24082379; PMCID: PMC3783123.
2.
Wada et al.
General Thoracic and Cardiovascular Surgery Cases https://doi.
org/10.
1186/s44215-024-00145-7 3.
Santillo E, Migale M, Marini L, Fallavollita L, Massini C, Balestrini F.
Left atrial myxoma development after radiofrequency ablation of an atrial flutter substrate.
JC Cases.
2015;11:124-6.
4.
Kahraman, D.
Et.
Al.
Refractory anemia and myxoma after radiofrequency ablation: a case report.
Cardiovasc Surg Int 2016;3(1):15-17 http://dx.
doi.
org/DOI: 10.
5606/e-cvsi.
2016.
479 5.
Islam, AKMM.
Cardiac Myxomas: A narrative Review.
World J Cardiol 2022 April 26; 14(4): 206-219.
10.
4330/wjc.
v14.
14.
206 6.
Satomi, K.
Editorial: Incidental tumor or ablation-promoted oncogenesis? Journal of Cardiology Cases.
12 (2015) 30-31.
http://dx.
doi.
org/10.
1016/j.
jccase.
2015.
04.
001 7.
AlAhmadi HH, Alsafwani NS, Shawarby MA, Ahmed F.
Cardiac Myxoma: Typical Presentation but Unusual Histology.
Case Rep Med.
2021 May 4;2021:6611579.
doi: 10.
1155/2021/6611579.
PMID: 34035819; PMCID: PMC8116158.
8.
Lee VH, Connolly HM, Brown RD.
Central Nervous System Manifestations of Cardiac Myxoma.
Arch Neurol.
2007;64(8):1115–1120.
doi:10.
1001/archneur.
64.
8.
1115 9.
Okongwu CC, Olaofe OO.
Cardiac myxoma: a comprehensive review.
J Cardiothorac Surg.
2025 Mar 13;20(1):151.
doi: 10.
1186/s13019-024-03333-2.
PMID: 40082903; PMCID: PMC11905437.
10.
El Sabbagh, A, Al-Hijji, M, Thaden, J.
et al.
Cardiac Myxoma: The Great Mimicker.
J Am Coll Cardiol Img.
2017 Feb, 10 (2) 203–206.
https://doi.
org/10.
1016/j.
jcmg.
2016.
06.
018 11.
I.
M.
Keeling, P.
Oberwalder, M.
Anelli-Monti, H.
Schuchlenz, U.
Demel, G.
P.
Tilz, P.
Rehak, B.
Rigler, Cardiac myxomas: 24 years of experience in 49 patients, European Journal of Cardio-Thoracic Surgery, Volume 22, Issue 6, December 2002, Pages 971–977, https://doi.
org/10.
1016/S1010-7940(02)00592-4 12.
Ngow HA, Khairina WM.
Atrial myxoma: histological confirmation.
Heart Asia.
2011 Jan 1;3(1):43-4.
doi: 10.
1136/ha.
2010.
003046.
PMID: 27325987; PMCID: PMC4898555.
13.
Hamdan, M.
, Alam, B.
& Kossaify, A.
A polo ball in the right atrium, importance of echocardiographic characteristics of intracardiac myxomas: a case report.
J Med Case Reports 17, 403 (2023).
https://doi.
org/10.
1186/s13256-023-04130-6.
14.
Wang JG, Li YJ, Liu H, Li NN, Zhao J, Xing XM.
Clinicopathologic analysis of cardiac myxomas: Seven years experience with 61 patients.
J Thorac Dis 2012;4 (3):272-283.
DOI: 10.
3978/j.
issn.
2072-1439.
2012.
05.
07.
15.
Zahra, K, Salma, S, Ali, T.
et al.
Giant Right Atrial Myxoma: Multimodality Imaging and Management.
J Am Coll Cardiol Case Rep.
2025 Jan, 30 (2) https://doi.
org/10.
1016/j.
jaccas.
2024.
102772.
16.
Cotrim, N, Veiga, A, Castilho, B.
et al.
Giant Cardiac Myxoma as a Cause of Stroke.
J Am Coll Cardiol Case Rep.
2024 Dec, 29 (24).
https://doi.
org/10.
1016/j.
jaccas.
2024.
102866.
17.
Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, AnastasiouNana M.
Cardiac tumors.
ISRN Oncol.
2011;2011:208929.
doi: 10.
5402/2011/208929.
Epub 2011 May 26.
PMID: 22091416; PMCID: PMC3195386.
18.
Nektaria M, Theologou S, Christos C, George S, Rokeia E, Dimitrios S, Ioanna P.
Cardiac myxomas: A single-center case series of 145 patients over a 32-year period study.
Ann Card Anaesth.
2023 Jan-Mar;26(1):17-22.
doi: 10.
4103/aca.
aca_290_20.
PMID: 36722583; PMCID: PMC9997480.
19.
Sido V, Volkwein A, Hartrumpf M, Braun C, Kühnel RU, Ostovar R, Schröter F, Chopsonidou S, Albes JM.
Gender-Related Outcomes after Surgical Resection and Level of Satisfaction in Patients with Left Atrial Tumors.
J Clin Med.
2023 Mar 6;12(5):2075.
doi: 10.
3390/jcm12052075.
PMID: 36902863; PMCID: PMC10003994.
20.
Lima NA, Byers-Spencer K, Cwikla K, Huffman C, Diaz M, Melgar TA, Helmstetter N.
Benign Cardiac Neoplasms in the United States: A Thirteen-Year Review.
Cardiology.
2021;146(6):748-753.
doi: 10.
1159/000519290.
Epub 2021 Sep 1.
PMID: 34469887; PMCID: PMC8743935.
21.
Saleh Y, Hammad B, Almaghraby A, Abdelkarim O, Seleem M, Abdelnaby M, Shehata H, Hammad M, Ramadan B, Elshafei M, Elsharkawy E, Abdel-Hay MA.
Carney Complex: A Rare Case of Multicentric Cardiac Myxoma Associated with Endocrinopathy.
Case Rep Cardiol.
2018 Jul 2;2018:2959041.
doi: 10.
1155/2018/2959041.
PMID: 30065853; PMCID: PMC6051319.
22.
Amano J, Kono T, Wada Y, Zhang T, Koide N, Fujimori M, Ito K.
Cardiac myxoma: its origin and tumor characteristics.
Ann Thorac Cardiovasc Surg.
2003 Aug;9(4):215-21.
PMID: 13129418.
23.
Orlandi A, Ciucci A, Ferlosio A et al (2006) Cardiac myxoma cells exhibit embryonic endocardial stem cell features.
J Pathol 209(2):231-239.
https://doi.
org/10.
1002/path.
1959.
24.
Sakamoto H, Sakamaki T, Sumino H, Sawada Y, Sato H, Sato M, Fujita K, Kanda T, Tamura J, Kurabayashi M.
Production of endothelin-1 and big endothelin-1 by human cardiac myxoma cells- -implications of the origin of myxomas--.
Circ J.
2004 Dec;68(12):1230-2.
doi: 10.
1253/circj.
68.
1230.
PMID: 15564714.
25.
Singhal P, Luk A, Rao V, Butany J (2014) Molecular basis of cardiac myxomas.
Int J Mol Sci 15(1):1315–1337.
https://doi.
org/10.
3390/ijms15011315.
26.
Sughimoto K.
, Shiikawa A.
, Ohkado A.
, Nanaumi M.
Multiple cardiac myxomas with pulmonary artery obstruction and acute right heart failure.
Jpn.
J.
Thorac.
Cardiovasc.
Surg.
2004;52:530–533.
doi: 10.
1007/s11748-004-0005-3.
27.
Mendyka D, Płonek T, Jędrasek T, Korman A, Złotowska A, Jędrasek A, Skalik R, Kustrzycki W.
The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review.
J Clin Med.
2024 Dec 28;14(1):121.
doi: 10.
3390/jcm14010121.
PMID: 39797207; PMCID: PMC11722112.
28.
Changing management of cardiac myxoma based on a series of 40 cases with long-term follow-up Selkane, Chekir et al.
The Annals of Thoracic Surgery, Volume 76, Issue 6, 1935 – 1938.
29.
Argueta EE, Ratheal K, Prieto S, Paone R, Jenkins LA, Oyenuga O.
Recurrent atrial myxoma, right atriotomy, and sinus node dysfunction: a case of interdisciplinary care.
The Southwest Respiratory and Critical Care Chronicles 2018;6(23):42–46.
30.
Scalise M, Torella M, Marino F, Ravo M, Giurato G, Vicinanza C, Cianflone E, Mancuso T, Aquila I, Salerno L, Nassa G, Agosti V, De Angelis A, Urbanek K, Berrino L, Veltri P, Paolino D, Mastroroberto P, De Feo M, Viglietto G, Weisz A, Nadal-Ginard B, Ellison-Hughes GM, Torella D.
Atrial myxomas arise from multipotent cardiac stem cells.
Eur Heart J.
2020 Dec 1;41(45):4332-4345.
doi: 10.
1093/eurheartj/ehaa156.
PMID: 32330934; PMCID: PMC7735815.
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