Giant obstructive left atrial myxoma Avakian SD et al CLINICS 2012;67(7):853-854 Figure 1 - Giant obstructive left atrial mixoma (arrows) in systole and diastole. is the most important method for the differential diagnosis with primary valve disease. Moreover, it can estimate the transvalve gradient. It has been reported that patients with left atrial myxomas have reduced transmitral blood flow. Nevertheless, only large myxomas can resemble severe mitral stenosis. The differential diagnosis of an intracardiac mass encompasses benign and malignant primary heart tumors, metastatic tumors and thrombi. Eletrocardiographic findings are unspecific. The cardiac rhythm is usually normal. Chest X- ray may reveal an enlargement of the left atrium and some signs of pulmonary hypertension and congestion. Calcifi- cations, which make the tumor visible on routine radio- graphic examination, are unusual. Computed tomography and magnetic resonance imaging can differentiate tissue composition, making it possible to identify the nature of the mass. The preoperative diagnosis of cardiac tumors could be performed correctly utilizing angiography, echocardiogra- phy, or both. Coronary angiography is reserved for older patients who may have coexisting coronary artery disease (9). Controversy remains regarding the optimal operative approach to atrial myxomas. The biatrial approach has been advocated to achieve the most complete tumor excision and assess the possibility of tumors in the right atrium (10). Other options include minimally invasive thoracoscopic surgery and the use of robotic technology. Surgical excision of the tumor appears to be curative, and recurrence is rare, as shown five years later in an echocardiogram of this patient. AUTHOR CONTRIBUTIONS All of the authors participated in manuscript preparation, data collection and data interpretation. All of the authors read and approved the final manuscript. REFERENCES 1. Silverman NA. Primary cardiac tumors. Ann Surg. 1980;191(2):127-138, http://dx.doi.org/10.1097/00000658-198002000-00001. 2. Johansson L. Histogenesis of cardiac myxomas. An immunohistochemical study of 19 cases including one with glandular structures and review of the literature. Arch Pathol Lab Med. 1989;113(7):735-41. 3. Reynen K. Cardiac myxomas. N Eng J Med. 1995;333(24):1610–7, http:// dx.doi.org/10.1056/NEJM199512143332407. 4. Shimono T, Makino S, Kanamori Y, Kinoshita T, Yada I. Left atrial myxomas: Using gross anatomic tumor types to determine clinical features and coronary angiographic findings. Chest. 1995;107(3):674-679, http:// dx.doi.org/10.1378/chest.107.3.674. 5. Swartz MF, Lutz CJ, Chandan VS, Landas S, Fink GW. Atrial Myxomas: Pathologic Types, Tumor Location, and Presenting Symptoms. J Card Surg. 2006;21(4):435-40, http://dx.doi.org/10.1111/j.1540-8191.2006.00265.x. 6. Jung R, Ghahramani A, Mallon S, Richter S, Sommer L, Gottlieb S, Myerburg R. Hemodynamic features of prolapsing and nonprolapsing left atrial myxoma. Circulation. 1975;51(5):342–9. 7. Schaff HV, Mullany CJ. Surgery for cardiac myxomas. Semin Thorac Cardiovasc Surg. 2000;12(2):77-88. 8. Pucci A, Gagliardotto P, Zanini C, Pansini S, di Summa M, Mollo F. Histopathologic and clinical characterization of cardiac myxoma: review of 53 cases from a single institution. Am Heart J. 2000;140(1):134–8, http://dx.doi.org/10.1067/mhj.2000.107176. 9. Larsson S, Lepore V, Kennergren C. Atrial myxomas: Results of 25 years’ experience and review of the literature. Surgery. 1989;105(6):695-8. 10. Jones DR, Warden HE, Murray GF, Hill RC, Graeber GM, Cruzzavala JL, et al. Biatrial approach to cardiac myxomas: A 30-year clinical experience. Ann Thorac Surg. 1995;59(4):851-6, http://dx.doi.org/10.1016/0003- 4975(95)00064-R. 854