Myxoma of the Left Atrium

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Abstract
The preoperative differentiation of myxoma of the left atrium from mitral stenosis is important for the successful outcome of surgery. Phonocardiographic studies were performed on 3 patients. One patient succumbed at surgery, the 2 remaining patients were operated successfully. The first apical and second pulmonic sounds were accentuated. The first sound was delayed, the Q-S1 interval measured 0.08-0.09 seconds. A mid-diastolic murmur with presystolic accentuation indistinguishable from that of mitral stenosis was heard in 2 patients. An opening snap and a Graham-Steell murmur were present in all 3 patients. The S2-OS interval varied between 0.055 - 0.11 second. Right heart catheterization revealed marked pulmonary hypertension and high pulmonary artery wedge pressure. Evidence is presented that an opening snap can occur in the presence of a normal mitral valve. It" is proposed that the opening snap is caused by the high atrioventricular gradient. All auscultatory abnormalities disappeared after the removal of the tumor.