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Left atrial myxoma with extensive calcification.

The patient was a 61-year-old male engineer whose history started in May 1977 with symptoms of mild dyspnoea on exercise and occasional palpitations. He had not had rheumatic fever and there was no family history of cardiac disease. He smoked 15 cigarettes per day. Examination at that time had revealed a malar flush, atrial fibrillation at 90 beats per minute, a blood pressure of 160/100 mmHg, a forceful apex beat, and an apical systolic murmur. A diagnosis of mild mitral regurgitation was made and digoxin 025 mg daily started to control his fibrillation. He stopped smoking and remained symptom-free until January 1980. His condition then deteriorated markedly with increasing dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, and ankle oedema. A chest radiograph showed a marked increase in heart size and the ECG showed atrial fibrillation with right bundle branch block. His cardiac failure was controlled with digoxin, 0 25 mg daily, frusemide 80 mg daily, and slow K 600 mg tds. In April 1980 he was referred to the Cardiothoracic Unit at Killingbeck Hospital, Leeds for possible mitral valve replacement. Examination revealed dyspnoea on mild exertion, controlled atrial fibrillation, a blood pressure of 110/70 mmHg, and a normal jugular venous pressure. His apex beat was in the sixth intercostal space in the anterior axillary line and a systolic thrill was palpable. A pansystolic murmur was audible over the praecordium, maximal at the apex and radiating to the left axilla. Bilateral basal crepitations were present. Clinically, he appeared to have moderate to severe mitral regurgitation. Investigations showed a haemoglobin of 14 4 g/dl with a normal white cell count, differential, and sedimentation rate. Chest radiography revealed an enlarged heart with an oval calcified mass lying in the region of the left atrium on the lateral view (fig 1). M-mode echocardiography indicated severe mitral regurgitation with good left ventricular function. The left atrium was moderately