Entire left atrial myxoma presenting as a saddle embolus.

A case is presented in which a complete left atrial myxoma became detached and lodged in the aortic bifurcation. Shortly after it had been removed the patient suffered cardiac arrest and could not be revived. The occurrence of saddle embolism of the aorta resulting from total expulsion of a left atrial myxoma is rare. Only five previous cases have been recorded. Three of them died-one without surgery within a few hours, one in the operating theatre, and the third on the ninth post-operative day. The other two cases survived following embolectomy. Brewin (1951) was the first to record a case in which the whole myxoma had embolized, without fragmentation, to the aortic bifurcation. Carter, Lowe, and Hill (1960) reported a case of aortic embolism in a woman of 60, in whom surgical removal of the embolus, consisting of 'typical myxomatous tissue', was followed by recovery. No intra-atrial tumour could be seen on angiography during convalescence, and the patient was well eight months later. In the case presented by Silverman, Olwin, and Graettinger (1962) several emboli seem to have occurred before the main tumour became detached and lodged at the aortic bifurcation. Embolectomy was performed but the patient died in renal failure on the ninth post-operative day. At necropsy a small tumour pedicle was found in the left atrium and tumour emboli and infarcts were found in the liver, spleen, left kidney, and right cerebral artery. Guthrie and Fairgrieve's (1963) case was a man of 57 who had an aortic embolus, without any previous symptoms of heart disease, the cause being a partly calcified myxoma from the left atrium which lodged in the abdominal aorta just below the diaphragm. Irreversible ventricular fibrillation occurred during attempted embolec-tomy. Bruneau and Stanley (1965) record a man of 50 who presented with a sudden paraplegia due to an embolus at the aortic bifurcation. A myxoma was removed from this site and found to be complete , including its pedicle. Nine months later he suffered a left hemiplegia and angiography revealed a filling defect in the left atrium. At operation three myxomata were found in the atrium and these were successfully removed. A 61-year-old man, while out walking, experienced palpitation and faintness, followed by a painful sensation in his legs as if hot water were being poured over them. His legs also began to feel heavy, became weak, and gave way. The pain gradually centred in …