Abstract
Echocardiography has a considerable impact on the surgical strategy employed during cardiac surgery. However, emergency surgeries generally do not permit the thorough evaluation of patients. The addition of a dedicated perioperative ultrasonographer to our surgical team has allowed for perioperative evaluations such as transthoracic echocardiography (TTE) to easily be performed on patients undergoing elective or emergency surgeries. There are no reports in the literature on the benefit of a dedicated perioperative ultrasonographer performing preoperative TTEs. We herein report a case of a left atrial myxoma and associated mitral valve (MV) prolapse that was detected by the perioperative ultrasonographer preoperatively and treated simultaneously with tumor resection and mitral valve annuloplasty (MVA). A 68-year-old female patient was diagnosed with congestive cardiac failure on admission to a nearby hospital. TTE revealed a massive mass in the left atrium and moderate mitral regurgitation (MR). She was transferred to our hospital for surgery. The perioperative ultrasonographer reviewed the TTE and found a slight deviation of the A3 anterior MV leaflet towards the apex, which had been theorized to be the site of MR. The findings were promptly reported to the anesthesiologist and cardiovascular surgeon; subsequently, tumor resection and MVA were performed. The tumor mass had a stalk attached to the atrial septum. MV degeneration and excessive leaflet tissue of the A3 anterior leaflet were found. Moreover, the diameter of the valvular ring was enlarged, resulting in a defect of the junction between the anterior and posterior leaflets. The regurgitation was stabilized. Left atrial myxoma is frequently correlated with MR, which is challenging to accurately detect and evaluate for the severity thereof. Particularly within the limited time frame, the perioperative ultrasonographer was able to promptly perform the TTE and share the findings with the surgical team. This led to selection of the appropriate preoperative evaluation and surgical procedure.
