Preoperative exclusion of significant coronary artery disease by 64-slice CT coronary angiography in a patient with a left atrial myxoma
Rafic F. Berbarie, MD, Mohammed K. Aslam, MD, Johannes J. Kuiper, MD, Gregory J. Matter, MD, Alan W. Martin, MD, William C. Roberts, MD, and Jeffrey M. Schussler, MD
A 49-year-old man without any significant past medical history presented to the emergency department with complaints of diploplia, paresthesias in both arms, vertigo,
tinnitus in the right ear, and dysarthria. Physical examination was unremarkable. A computed tomographic (CT) scan of the head was normal. These symptoms resolved within several hours,
consistent with a transient ischemic attack. Magnetic resonance imaging of the brain revealed acute infarcts in the left cerebellar hemisphere and in the right occipital lobe, suggesting a
thromboembolic source. Transesophageal echocardiography disclosed a 2 x 2-cm mass attached to the left atrial aspect of the atrial septum, and surgical excision was planned. As the patient was
considered to have a very low risk for the presence of significant arterial narrowing, he underwent a 64-slice cardiac CT scan rather than invasive coronary angiography. The scan demonstrated
minimal plaque in the coronary arteries. Subsequently, the patient's left atrial mass was excised without complication, and the mass was a typical myxoma. This case demonstrates how, in the future,
routine invasive coronary angiography may not be necessary as part of the workup for noncoronary cardiac surgery.
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