Intra-atrial mass-thrombus versus myxoma, post-amplatzer atrial septal defect closure device deployment.

From the *Department of Internal Medicine, Pinnacle Health Hospitals, Harrisburg, Pennsylvania; †Department of Cardiology, Pinnacle Health Cardiovascular Institute, Harrisburg, Pennsylvania; and the ‡Department of Cardiothoracic Surgery, Pinnacle Health Cardiovascular Institute, Harrisburg, Pennsylvania; Drs. Maini, Mumtaz, and Mandak are employees of Pinnacle Health Cardiovascular Institute. Dr. Mandak is a member of the speaker’s bureau for Forest and Glaxo SmithKline (GSK). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received December 9, 2011; A64-year-old Caucasian male who had percutaneous closure of a patent formaen ovale (PFO) presented for follow-up 2 years later. A shows a transesophageal echocardiogram (TEE) of: 1) a left atrial (LA) mass; 2) the LA mass arising from the atrial septal defect (ASD) closure device; and 3) the protrusion of the mass into the left ventricle (LV). The mass was large and hyper mobile, flopping into the mitral inflow tract consistent with a thrombus versus a myxoma. Surgical excision was indicated given the size, mobility, and danger of embolization. B shows a: 1) 6 5.5 1.5 cm brownish gelatinous mass; 2) amplatzer device; and 3) the site of attachment to the ASD/PFO closure device. Histopathological analysis confirmed myxoma. C shows TEE at the time of original diagnosis of PFO; no mass was noted in the LA. This case represents a surprising outcome of a surveillance TEE (Online Video 1) following percutaneous ASD closure. Previous case reports have described myxoma growth rates of up to 2.2 mm/month (1). The growth rate in this case was 2.5 mm/month, suggesting that growth rate alone is not an adequate distinguishing feature for thrombus versus myxoma. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.01.076