Stefan Sanger1, Laszlo Goeboeloes1, Arun Kumar1, Nuno Raposo1, Gopal Bhatnagar1

1Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Background:
Left atrial myxomas are the most common benign tumours of the heart. A voluminous atrial mass may result in an acute cardiopulmonary decompensation by restriction of the left ventricular inflow, and cause acute pulmonary oedema accompanied by a circulatory shock. We present a case in the current COVID-19 pandemic, where the challenging access to standard health screening led to a life-saving, emergency procedure to remove an undetected giant left atrial myxoma.

Method(s):
A 45-year-old female patient presented to a district hospital with coughing, severe shortness of breath at the local height of the COVID-19 pandemic, was diagnosed with the disease, and received a full antiviral treatment. She has recovered from the relatively severe disease course within two weeks, and had two negative viral swab results prior to discharge home. Ten days later, she was re-admitted with similar presenting complaints and new onset of chest pain. The chest X-ray on admission revealed pulmonary oedema accompanied by patchy infiltrations, raising the possibility of a recurrent chest infection. Due to the sudden chest pain,  echocardiography was undertaken, demonstrating a large, prolapsing tumour through the mitral valve, almost completely filling the left atrial cavity. During the echocardiographic examination, the patient has acutely decompensated and was urgently transferred to our hospital for emergency removal of the atrial mass.

Result(s):
The procedure was performed under antiviral precautions, and the 60×40 mm myxoma was successfully removed. The histological investigations have confirmed the preliminary diagnosis; the patient had an uneventful postoperative course.

Conclusion(s):
This case highlights the importance a thorough assessment of patients even in a pandemic era; hence other underlying severe co-morbidities might be missed focusing only on the viral infection, leading to a life-threatening condition in short-term.