Subtle Symptoms of Large Biatrial Myxomas: A Case Study and Surgical Insights.

BACKGROUND Primary cardiac tumors are not as common as metastatic tumors, and biatrial masses are seldom benign and need differentiation from malignant tumors. Myxomas are usually unilateral, and biatrial myxomas are rare. They can also be associated with Carney complex and its subsets. This case highlights the unusual presentation of massive biatrial myxomas, with minimal symptoms. CASE REPORT A 46-year-old woman with asthma presented with worsening dyspnea and palpitations and was initially treated for asthma exacerbation; however, the symptoms continued to worsen, which led to further investigation. Computed tomography pulmonary angiography was done, which ruled out pulmonary involvement but revealed huge biatrial masses, right atrial component measuring 8.8×6.8 cm, and the left atrial component measuring 5.6×5.2 cm, which were confirmed on the transthoracic echocardiogram, along with low left ventricular ejection fraction (LVEF). Given the high-risk features and high suspicion of malignancy, an open surgical biopsy was done, and the mass turned out to be atrial myxoma. After appropriate staging, extensive surgical resection was done, with subsequent repair of the interatrial septum that was involved by the masses. The patient tolerated the surgery well and on follow-up was found to have symptomatic improvement, decrease in the size of atrial chambers, and normalization of LVEF. CONCLUSIONS Myxomas, although rare, can be biatrial and grow significantly, causing minimal symptoms. Malignancy should always be excluded in such high-risk atrial masses, but myxomas should be included in differential diagnoses for exertional dyspnea.