Angiomyxoma of the Left Auricle

Primary tumours of the heart are uncommon. Various authors estimated their frequency at autopsy as follows: Rand and Sachs (1943), o.5 per cent.; Straus and Merliss (I945), 0.0017 per cent.; Lymburner (1934), o.6I per cent. About three-quarters are benign and about half of the benign tumours are the so-called myxomas. Approximately 70 per cent. of these myxomas arise in the left auricle in the neighbourhood of the fossa ovalis, the majority of the remainder arising in the same situation in the right auricle. Occasional examples have been seen on the cusps of valves. The term myxoma which only indicates a peculiar feature of collagenous stroma probably in part degenerative (Raeburn, I952) has little merit and has led to needless confusion. Better terms are hamartoblastoma or angiomyxoma as they arise from elements of pre-existing intramural hamartomas. They may present at any age but the majority do so in the third to sixth decade. The establishment of an accurate diagnosis of primary neoplasms as forecast by Mahaim (I945) has been assisted by the development of angiocardiography, and the intracavitary position of the primary angiomyxomas means that this technique is especially useful in establishing a clinical diagnosis. Both Brock (I956) and Scannell et al. (I956) have stressed the desirability of making a clinical diagnosis as the preparation of the patient and the surgical approach to these tumours when in the left auricle is different from that for mitral valvulotomy. Pritchard (I95I) reviewed I27 primary myxomas of the heart. Ante-mortem diagnosis was not made in one case. Since then over 30 cases have been reported and in I4 cases an ante-mortem diagnosis was made. Successful removal has been performed in three. The case reported here illustrates the rapidity with which the clinical manifestations of a tumour may develop. Clinical Details 54.2zoo. H.G.S. Aged 59 years. First attended the Gordon Hospital Outpatients in December, I954, complaining of constipation together with intermittent rectal bleeding. At this time he complained of no symptoms referable to the cardio-vascular and respiratory systems. B.P. 150/95. Physical examination of the lower distal colon and rectum revealed no abnormality and a barium enema examination was within normal limits. The patient was admitted as an emergency on April I6, 1955. On admission he was very dyspnoeic, orthopnoeic, restless and uncooperative. A history from relatives revealed that he had suffered from progressive shortness of breath, asthma and restlessness of sudden onset 48 hours before admission. On examination he looked very ill andt was dyspnoeic and orthopnoeic. There was cyanosis of finger tips and ears. ' The accessory respiratory muscles were prominent but the respiratory excursion was poor with expiratory wheezing. The apex beat was i6o/min. with a pulse rate of 84/min. Owing to the tachycardia the heart sounds could not be heard well. There was no thrill or murmur. A clinical diagnosis of auricular fibrillation was confirmed by an electrocardiograph. The jugular venous pressure was raised, the liver was enlarged and tender and there was slight pitting oedema of the ankles. A clinical diagnosis of congestive heart failure with auricular fibrillation was made and the patient was digitalised, given diuretics and sedated. However, the condition of the patient gradually deteriorated and he died on April I9, I955, three days after admission. Owing to the severity of the patient's condition further investigation of the cardio-vascular system could not be carried out.