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A case of cardiac myxoma with obstructive symptoms: Recognizing key early signs for improved diagnosis Filano, Marco; Kuhn, Corinna Maria; Zhao, Zihan; Laukkanen, Noora Julia; Rahimah, Anna Fuji; Karolina, Wella; Prasetya, Indra; Rohman, Mohammad Saifur
Heart Science Journal Vol. 7 No. 1 (2026): Accelerating Clinical Breakthroughs: The Journey from Molecular Discovery to Pa
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.01.21

Abstract

Background: LA myxoma is the most common primary cardiac tumor, often presenting with obstructive symptoms when the tumor prolapses into the mitral valve during diastole. On the other hand, rheumatic MS leads to fixed obstruction of the mitral valve. The coexistence of both conditions is extremely rare and can exacerbate the severity of mitral inflow obstruction. Early recognition of this dual pathology through careful clinical evaluation and echocardiographic assessment is crucial for timely and effective management. Case Presentations: A 66-year-old female patient presented with progressive dyspnea. Transthoracic echocardiography detected a mobile mass in the left atrium and later identified it as a cardiac myxoma. Further evaluation revealed severe rheumatic mitral stenosis (MS) with a mitral valve area (MVA) measured by planimetry at 1.23 cm², restricting the mass from slipping into the left ventricle during the diastolic phase. Based on the conference decision, tumor resection was performed, and the histopathological examination revealed a left atrial (LA) myxoma. The dual obstruction caused by mitral valve stenosis and a left atrial myxoma resulted in life-threatening symptoms due to diastolic obstruction of mitral inflow. In isolated LA myxoma, the tumor pushes into the mitral valve opening during the heart's relaxation phase, blocking blood flow from the left atrium to the left ventricle and raising pressure in the atrium and lungs. When significant MS is present, the narrowed valve further worsens this obstruction, leading to higher atrial pressure and more severe heart failure symptoms. Both conditions commonly present with early symptoms such as exertional dyspnea, palpitations, signs of heart failure like edema and pulmonary crackles, diastolic murmur, and sometimes syncope caused by reduced cardiac output. Conclusions: This case highlights the critical importance of identifying early obstructive symptoms indicative of cardiac myxoma. Timely identification of these clinical manifestations can facilitate earlier diagnosis, improve patient outcomes, and prevent potentially fatal complications.
Severe diffuse multivessel coronary calcification in first-degree relatives: A case series Suryo Baskoro, Shalahuddin; Ramadhiani, Risa; Filano, Marco; Saifur Rohman, Muhammad
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.16

Abstract

Background: Coronary artery disease (CAD) in first degree relatives may represent a clinical pattern associated with diffuse calcification, extensive vessel involvement, and increased procedural complexity. Such cases often present with severe multivessel disease that may require advanced revascularization strategies. Case Presentations: Three related patients aged 66–71 years, consisting of three first-degree relatives, presented with progressive angina despite optimal medical therapy. Hypertension was present in all, dyslipidemia in two, and one male had heart failure with mildly reduced ejection fraction (41%). None had diabetes, chronic kidney disease, or a smoking history. Coronary angiography revealed diffuse, heavily calcified three-vessel disease in two patients and two vessel disease in one patient. The first case (71F) underwent drug-eluting stent (DES) implantation in the left anterior descending (LAD) artery; right coronary artery (RCA) lesion preparation/atherectomy was attempted but definitive RCA stenting was not performed, and the RCA was managed conservatively. The second case (66M) had chronic total occlusions of the RCA and LCx, with rotablator-assisted DES implantation performed on the target lesion. The third case (68F) had a critical OM1 lesion treated with DES; a moderate LAD lesion was assessed with diastolic hyperemia-free ratio (DFR) and confirmed ischemia prior to staged LAD DES implantation. All procedures were completed without periprocedural complications. Conclusions: These related cases demonstrated a recurring angiographic pattern of diffuse, calcified multivessel CAD, suggesting complex interplay between metabolic risk factor and potential hereditary component.
Predictors of major adverse cardiovascular events after percutaneous coronary intervention in premature coronary artery disease: An Indonesian single-centre cohort study Suryo Baskoro, Shalahuddin; Noverikhe, Nikhen; Herbani, Merlita; Filano, Marco; Veliawan, Zhafran; Yolanda, Anindia Reina; Wulandari, Ayu Paramitha; Rohman, Muhammad Saifur; Satrijo, Budi
Heart Science Journal Vol. 7 No. 4 (2026): Navigating High-Risk Cardiovascular Subsets: Premature Disease, Plaque Complexi
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.04.8

Abstract

Background: Premature coronary artery disease (PCAD) is increasingly recognised in Asian percutaneous coronary intervention (PCI) practice, yet baseline predictors of major adverse cardiovascular events (MACE) after revascularisation remain poorly characterised.Objective: To identify independent baseline predictors of MACE after PCI in PCAD and determine whether a stricter "Asia Pacific" age band discriminates risk within the premature range.Methods:  Retrospective cohort study at a tertiary PCI centre in Malang, Indonesia (January 2022–March 2025; follow-up censored 1 May 2026). Patients meeting 2019 ACC/AHA PCAD criteria (men <55 years or women <65 years) with confirmed obstructive coronary artery disease (CAD) treated by PCI were enrolled. The primary outcome was composite MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart-failure hospitalisation, or unplanned revascularisation), assessed by cause-specific Cox proportional-hazards regression.Result: Among 318 patients who completed follow-up (median age 50 years; 31.4% women; median follow-up 930.5 days), 41 MACE events occurred (12.9%). MACE incidence was similar between Asia Pacific PCAD (n=159; 11.3%) and Older PCAD (n=159; 14.5%; 3-year cumulative incidence 12.0% vs 16.9%; log-rank p=0.308). Reduced left ventricular ejection fraction (LVEF <40%) and dyslipidaemia were independent baseline predictors (LVEF <40%: adjusted HR 1.79, 95% CI 1.09–2.95; dyslipidaemia: adjusted HR 3.84, 95% CI 2.09–7.07; C=0.717, bootstrap-corrected C=0.715 (1000 resamples; optimism +0.002)).Conclusion: Reduced LVEF and dyslipidaemia were the principal baseline predictors of MACE in this Indonesian single-centre PCAD post-PCI cohort; age stratification within the premature range did not discriminate risk. Results should be interpreted in the context of 29.3% loss to follow-up and single-centre design.