A Rare Presentation: Giant Left Ventricular Myxoma Causing Acute Lower Limb Ischemia in a Pediatric Patient

Mircea Kutrupiya^*
*Correspondence: Mircea Kutrupiya, Department of Pediatrics, University Hospital Brandenburg a.d.H., Brandenburg an der Havel, Germany, Email:

Keywords

Left ventricular myxoma • Cardiac tumor • Pediatric patient • Acute limb ischemia

Introduction

Left ventricular myxomas are rare primary cardiac tumors that predominantly affect adults and are exceedingly uncommon in pediatric patients. These tumors arise from the endocardium and typically manifest as intracardiac masses attached to the atrial septum, most commonly in the left atrium. While left ventricular myxomas represent a small fraction of all cardiac tumors, they can have significant clinical implications due to their potential to obstruct blood flow, embolize, or cause arrhythmias. The presentation of left ventricular myxomas with acute lower limb ischemia is exceptionally rare, with only a few cases reported in the literature. Here, we present a case of a giant left ventricular myxoma causing acute lower limb ischemia in a pediatric patient and review the existing literature on this unusual presentation [1].

Literature Review

Left ventricular myxomas are typically asymptomatic and may be incidentally detected on imaging studies performed for unrelated reasons. However, when symptomatic, left ventricular myxomas can present with a wide range of clinical manifestations, including dyspnea, chest pain, palpitations, syncope and signs of systemic embolization. Acute limb ischemia secondary to left ventricular myxoma obstruction of the left ventricular outflow tract is an exceedingly rare presentation, with only a handful of cases reported in the literature. The pathophysiology of acute limb ischemia in the setting of left ventricular myxoma involves obstruction of blood flow to the lower extremities due to mechanical compression of the aorta or iliac arteries by the tumor mass. In some cases, thromboembolism from the myxoma itself or associated atrial fibrillation may also contribute to acute limb ischemia. Prompt recognition and intervention are crucial to prevent limb-threatening complications and minimize morbidity and mortality associated with acute limb ischemia. Surgical resection of the left ventricular myxoma is the cornerstone of management, aimed at relieving obstruction, restoring blood flow and preventing systemic embolization. In pediatric patients, surgical intervention may pose unique challenges due to smaller cardiac anatomy and limited tolerance for ischemia. However, timely surgical resection is essential to prevent irreversible tissue damage and preserve limb function [2,3].

Discussion

The presented case of a giant left ventricular myxoma causing acute lower limb ischemia in a pediatric patient underscores the importance of considering rare etiologies in the differential diagnosis of acute limb ischemia, particularly in cases where conventional causes are not readily apparent. Left ventricular myxomas are uncommon cardiac tumors, especially in pediatric populations and their presentation with acute limb ischemia is exceptionally rare. However, prompt recognition and intervention are crucial to prevent limb-threatening complications and minimize morbidity and mortality associated with acute limb ischemia [4]. The pathophysiology of acute limb ischemia in the setting of left ventricular myxoma involves mechanical obstruction of blood flow to the lower extremities due to compression of the aorta or iliac arteries by the tumor mass. Additionally, thromboembolism from the myxoma itself or associated atrial fibrillation may contribute to acute limb ischemia. Timely surgical resection of the myxoma is paramount for relieving obstruction, restoring blood flow and preventing systemic embolization. In pediatric patients, surgical intervention may pose unique challenges due to smaller cardiac anatomy and limited tolerance for ischemia. However, urgent surgical resection is essential to prevent irreversible tissue damage and preserve limb function. Furthermore, this case highlights the importance of interdisciplinary collaboration between cardiologists, vascular surgeons and pediatric specialists in the management of complex cases involving cardiac tumors and acute limb ischemia. Close coordination among multidisciplinary teams is essential for timely diagnosis, risk stratification and treatment planning, particularly in pediatric patients who may require specialized care and interventions [5,6].

Conclusion

In conclusion, the presented case illustrates a rare but clinically significant manifestation of left ventricular myxoma presenting with acute lower limb ischemia in a pediatric patient. While left ventricular myxomas are rare cardiac tumors, their presentation with acute lower limb ischemia poses significant diagnostic and therapeutic challenges, particularly in pediatric patients. Clinicians should maintain a high index of suspicion for cardiac tumors in the differential diagnosis of acute limb ischemia, particularly in cases where conventional etiologies are not readily apparent. Prompt recognition, imaging and surgical intervention are essential for optimizing outcomes and preserving limb function in patients with left ventricular myxoma-associated acute limb ischemia. Continued vigilance and interdisciplinary collaboration are crucial for ensuring timely diagnosis and appropriate management of rare cardiac tumors in pediatric populations.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. Linnemeier, Laura, Brian D. Benneyworth, Mark Turrentine and Mark Rodefeld, et al. "Pediatric cardiac tumors: A 45-year, single-institution review." World J Pediatr Congenit Heart Surg 6 (2015): 215-219.

Google Scholar, Crossref, Indexed at

2. Uzun, Orhan, Dirk G. Wilson, Gordon M. Vujanic and Jonathan M. Parsons, et al. "Cardiac tumours in children." Orphanet J Rare Dis 2 (2007): 1-14.

 Google Scholar, Crossref, Indexed at

3. Chlebowski, Meghan, James O'Brien, Casey Hertzenberg and Jonathan Wagner. "Asymptomatic left ventricular myxoma in a 12-year-old male." Tex Heart Inst J 43 (2016): 267-269.

Google Scholar, Crossref, Indexed at

4. Macias, Eduardo, Elizabeth Nieman, Kentaro Yomogida and Orlando Petrucci, et al. "Rare presentation of an atrial myxoma in an adolescent patient: A case report and literature review." BMC Pediatr 18 (2018): 1-7.

Google Scholar, Crossref, Indexed at

5. Kumar, Prabhat and Anurag Garg. "Left ventricular myxoma in a child: A case report." Eur J Echocardiogr 12 (2011): E23-E23.

Google Scholar, Crossref, Indexed at

6. Azad, Sushil, Nilanjan Dutta, Kuntal Roy Chowdhuri and Tarun Raina Ramman, et al. "Atypical left ventricular myxoma: Unusual echocardiographic and histopathological features." World J Pediatr Congenit Heart Surg 11 (2020): NP129-NP131.

Google Scholar, Crossref, Indexed at