Abstract

NM-216

Pediatric "Stroke" due to Left Ventricle Myxoma

Helmholdt A, Kaminski E, Smith C
Children's Hospital of Michigan, Detroit, Michigan, United states

Most pediatric cardiac tumors are of primary cardiac origin and are relatively rare with an incidence of less than 3%.1 We report a case of a 14 year old adolescent female who initially presented to the emergency department with stroke-like symptoms (hemiparesis and expressive aphasia) and was subsequently diagnosed with a large left ventricular myxoma. The initial echocardiogram for stroke workup demonstrated that the entire LV outflow tract and most of the LV cavity was completely filled with tumor. Care was given to maintain preload and to optimize cardiac output during the induction of anesthesia. She emergently underwent a tumor resection with cardiopulmonary bypass. To optimize surgical visualization, both the superior and inferior vena cavae were cannulated to allow for an extended superior septal surgical approach. The mass was very friable and this likely contributed to its thromboembolic nature and patient symptom presentation.

The majority of the myxomas (75%)2 in pediatric patients are left atrial myxomas, with pediatric left ventricular (LV) myxomas being rarely described and often presenting asymptomatically3. Although myxomas are benign tumors, their location in the heart can lead to severe outflow obstruction which can impede cardiac output, sometimes leading to syncopal events and even sudden cardiac death.4 In this case, despite a near complete left-sided obstruction, the patient was asymptomatic prior to presentation and her initial presenting symptoms were not cardiac in nature. The preoperative and intraoperative anesthetic course was relatively uneventful with the exception of the short term need for milrinone and sodium nitroprusside post-bypass. The patient was discharged home on hospital day three with minimal sequelae and no residual neurologic deficits despite the notable size and location of her tumor.

References:
1. Juaneda I et al. A Rare Cause of Pediatric Stroke: Left Atrial Myxoma. World J Ped Congen Heart Surg. (2017) 8(2) 220-223.
2. Anesthesia for Congenital Heart Disease 3rd ed. Dean B.Andropoulos - Stephen A.Stayer - Emad B.Mossad - Wanda C.Miller-Hance - Wiley – 2015. pp 623-624
3. Chlebowski M et al. Asymptomatic Left Ventricular Myxoma in a 12-Year-Old Male. Texas Heart Inst J. (2016) 43(3) 267-269.
4. Schroeder L et al. Left Ventricular Myxoma. J Ped (2016) 168: 249.