Obstetrics, Neonatology, Cardiology, Cardiac Imaging, and Cardiac
Surgery
A right atrial tumor, characterized by transthoracic echocardiography in
image 1 appears to have a stalk like one might expect for an atrial
myxoma. The authors quickly involved the obstetrical and neonatology who
decided to promptly deliver a healthy baby. Involvement by other
clinical services usually results in more optimal outcomes as they
understand their “area” best. Given the unusual location as well as
shape they quite correctly involved their imaging experts (after
delivery of the child) for further delineation of structure.
Collaboration with imaging specialists is crucial in the diagnosis and
planning treatment of cardiac tumors, especially when question arises
regarding origin or extent. Improved understanding by collaboration with
the imaging experts is gained even in “simple” cases and is highly
recommended. The surgical resection was “radical” but unfortunately
despite this, the patient developed a local recurrence despite adjuvant
chemotherapy. Additional imaging in this case continued to show features
atypical for myxoma. While the authors chose primary surgical resection,
biopsy and neoadjuvant chemotherapy once malignancy is diagnosed is
another option. There is evidence of improved outcome with neoadjuvant
chemotherapy (2) and even microscopic residual tumor is associated with
reduced survival (3). However, knowledge regarding this is scarce and
collaboration with colleagues, both local and international is required
to answer such questions more completely (4). Interesting, early work on
local tumor margins are one example of attempts to improve resection
(5).