Living without left atrium.

To cite: Alvarez-Acosta L, Sanchez-Quintana A, FarraisVillalba M, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013009551 DESCRIPTION A 51-year-old female patient presented to the emergency room with a 3-month history of increasing dyspnoea, and 5 kg weight loss. Her medical history was not relevant. Physical examination revealed 100/90 mm Hg blood pressure, 98 bpm, orthostatic hypotension, a soft grade 2/6 systolic murmur at the left sternal border and bilaterally pulmonary rates. ECG showed normal sinus rhythm with left atrial enlargement. A transthoracic echocardiogram (figure 1A,C,D) revealed a large atrial myxoma occupying the majority of the left atrium, which prolapsed through the mitral valve during the entire cardiac cycle (videos 1, 3, 4 and 6). Grade II mitral regurgitation, severe mitral stenosis gradient and severe pulmonary hypertension were noted (videos 2 and 5). Left atrial myxoma excision (figure 1B) and pericardial patch implantation was performed with good recovery and no signs of heart failure to date.