{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:49:00Z","timestamp":1787748540800,"version":"build-2784847793"},"reference-count":47,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Primary cardiac tumors are exceedingly rare, with myxomas representing the most common benign type among these tumors, predominantly located in the left atrium. Biatrial involvement is an exceptional presentation, reported in less than 2.5% of cases. The terms bilateral and biatrial atrial myxoma are often confused and used interchangeably. We present a rare case of atrial myxoma involving both chambers, resected via a minimally invasive endoscopic approach, accompanied by a literature review. Case Presentation: A 52-year-old male with a three-month history of progressive fatigue and exertional dyspnea was found, on transthoracic echocardiography and cardiac MR, to have two intracardiac masses affecting both atria. Intraoperative transesophageal echocardiography confirmed the presence of mirror-image myxomas attached to the interatrial septum, in the absence of any septal defect. The tumors were excised en bloc, including the septal attachment, using a minimally invasive endoscopic approach. Histopathological examination confirmed the diagnosis of atrial myxoma, and the postoperative course was uneventful. Conclusions: Bilateral and biatrial atrial myxomas are exceedingly rare forms of cardiac tumors. In many cases, the first clinical manifestations may arise from cerebral or peripheral embolic events or from pulmonary thromboembolism. For this reason, screening echocardiography may be useful, particularly in cases of familial myxoma. Transthoracic and transesophageal echocardiography, combined with careful inspection of all cardiac chambers, play a crucial role in preventing recurrence by detecting small or overlooked tumor fragments. The minimally invasive endoscopic approach offers a safe and effective surgical option for biatrial myxomas, providing excellent visualization and facilitating thorough exploration of the cardiac cavities.<\/jats:p>","DOI":"10.3390\/medsci13040294","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:31:46Z","timestamp":1764689506000},"page":"294","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Atrial Myxoma in Both Chambers: Biatrial or Bilateral? A Rare Case Resected via Endoscopic Approach and Literature Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9044-8866","authenticated-orcid":false,"given":"Marius Mihai","family":"Harpa","sequence":"first","affiliation":[{"name":"Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Department of Cardiac Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9956-2312","authenticated-orcid":false,"given":"Emanuel-David","family":"Anitei","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, \r\nSciences and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Cardiac Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4742-3583","authenticated-orcid":false,"given":"Hussam","family":"Al Hussein","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embriology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaly","family":"Veres","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, \r\nSciences and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Anesthesia and Intensive Care, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3968-5118","authenticated-orcid":false,"given":"Simona","family":"Gurzu","sequence":"additional","affiliation":[{"name":"Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Roxana","family":"Opri\u0219","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, \r\nSciences and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiat Emilia","family":"Sorina","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Emergency Clinical Hospital, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1664-8130","authenticated-orcid":false,"given":"Emil Marian","family":"Arb\u0103na\u0219i","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, \r\nSciences and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudiu","family":"Ghiragosian","sequence":"additional","affiliation":[{"name":"Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Department of Cardiac Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4415-4357","authenticated-orcid":false,"given":"Cosmin Marian","family":"Banceu","sequence":"additional","affiliation":[{"name":"Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Department of Cardiac Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horatiu","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"},{"name":"Department of Cardiac Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7340-7472","authenticated-orcid":false,"given":"Robert","family":"Balan","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, \r\nSciences and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1378\/chest.52.6.828","article-title":"Bilateral atrial myxoma with successful removal: Report of a Case","volume":"52","author":"Yipintsol","year":"1967","journal-title":"Dis. Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"67","DOI":"10.5090\/kjtcs.2015.48.1.67","article-title":"An unusual biatrial cardiac myxoma in a young patient","volume":"48","author":"Azari","year":"2015","journal-title":"Korean J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"206","DOI":"10.4330\/wjc.v14.i4.206","article-title":"Cardiac myxomas: A narrative review","volume":"14","author":"Islam","year":"2022","journal-title":"World J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/his.12531","article-title":"The mysterious pathways of cardiac myxomas: A review of histogenesis, pathogenesis and pathology","volume":"66","author":"Mignogna","year":"2015","journal-title":"Histopathology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s11748-017-0811-z","article-title":"Giant biatrial myxoma with two different gross findings","volume":"66","author":"Kuroda","year":"2018","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_6","first-page":"7896180","article-title":"Recurrent Biatrial Myxomas in Carney Complex with a Spinal Melanotic Schwannoma: Advocacy for a Rigorous Multidisciplinary Follow-Up","volume":"2023","author":"Grandmougin","year":"2023","journal-title":"Case Rep. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/s41436-020-00956-3","article-title":"Predicting the risk of cardiac myxoma in Carney complex","volume":"23","author":"Pitsava","year":"2021","journal-title":"Genet. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/S1674-8301(11)60049-3","article-title":"Familial cardiac myxoma with multifocal recurrences: A case report and review of the literature","volume":"25","author":"Cao","year":"2011","journal-title":"J. Biomed. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Min, S.Y., Lim, Y.H., Lee, H.T., Shin, J., Kim, K.S., and Kim, H. (2014). Biatrial myxoma and multiple organ infarctions combined with Leriche syndrome in a female patient. BMC Cardiovasc. Disord., 14.","DOI":"10.1186\/1471-2261-14-175"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"236","DOI":"10.3904\/kjim.2000.15.3.236","article-title":"Multicentric biatrial myxoma in a young female patient: Case report","volume":"15","author":"Yoon","year":"2000","journal-title":"Korean J. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.xjtc.2023.11.014","article-title":"Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon\u2019s learning curve experience","volume":"23","author":"Dang","year":"2023","journal-title":"JTCVS Tech."},{"key":"ref_12","first-page":"507","article-title":"Two-time recurrence of a right atrial myxoma","volume":"28","author":"Kumary","year":"2015","journal-title":"Proc. (Bayl. Univ. Med. Cent.)"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/0003-4975(92)90676-U","article-title":"Clarence Crafoord and the first successful resection of a cardiac myxoma","volume":"54","author":"Chitwood","year":"1992","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S1054-8807(03)00087-5","article-title":"Surgical pathology of cardiac tumors. Two decades at an urban institution","volume":"12","author":"Odim","year":"2003","journal-title":"Cardiovasc. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Anitei, E.D., Harpa, M.M., Al Hussein, H., Ghiragosian, C., Stroe, V.I., Calburean, P., Gurzu, S., and Suciu, H. (2025). Pulmonary Valve Fibroelastoma, Still a Very Rare Cardiac Tumor: Case Report and Literature Review. Diagnostics, 15.","DOI":"10.3390\/diagnostics15030283"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1007\/s002469900425","article-title":"Massive biatrial myxomas in a child","volume":"20","author":"Cilliers","year":"1999","journal-title":"Pediatr. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ran, H., Chen, G., Hu, J., He, Y., Liu, J., Li, F., Liu, H., and Zhang, T. (2022). Case Report: Biatrial Myxoma with Pulmonary Embolism and Cerebral Embolism: Clinical Experience and Literature Review. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.812765"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"402","DOI":"10.14503\/THIJ-16-6017","article-title":"Recurrent Biatrial Myxoma in a 41-Year-Old Woman after Left Atrial Myxoma Resection","volume":"44","author":"Jia","year":"2017","journal-title":"Tex. Heart Inst. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1378\/chest.60.4.404","article-title":"Intracardiac myxoma in siblings","volume":"60","author":"Krause","year":"1971","journal-title":"Chest"},{"key":"ref_20","first-page":"155","article-title":"Familial Carney complex with biatrial cardiac myxoma","volume":"15","author":"Takigami","year":"2017","journal-title":"J. Cardiol. Cases."},{"key":"ref_21","unstructured":"Adam, M.P., Bick, S., Mirzaa, G.M., Pagon, R.A., Wallace, S.E., and Amemiya, A. (2025, November 03). Carney Complex, GeneReviews\u00ae, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK1286\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1530\/ERC-16-0246","article-title":"Growth hormone and risk for cardiac tumors in Carney complex","volume":"23","author":"Bandettini","year":"2016","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S0003-4975(98)00481-0","article-title":"Recurrent cardiac myxoma: Seeding or multifocal disease?","volume":"66","author":"Shinfeld","year":"1998","journal-title":"Ann. Thorac. Surg."},{"key":"ref_24","first-page":"715","article-title":"Second recurrence of familial cardiac myxomas in atypical locations","volume":"24","author":"Turhan","year":"2008","journal-title":"Can. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1111\/echo.14014","article-title":"\u201cGigantic\u201d biatrial myxoma with right heart functional impairment","volume":"35","author":"Gabrielli","year":"2018","journal-title":"Echocardiography"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e9558","DOI":"10.1097\/MD.0000000000009558","article-title":"Biatrial myxoma floating like a butterfly: A case report and review of the literature","volume":"97","author":"Li","year":"2018","journal-title":"Medicine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjcr\/ytaa401","article-title":"An exceptionally giant left atrial myxoma: A case report and literature review","volume":"4","author":"Hashem","year":"2020","journal-title":"Eur. Heart J.-Case Rep."},{"key":"ref_28","first-page":"3545480","article-title":"An Unusual Case of Biatrial Myxoma in a Young Female","volume":"2016","author":"Vijan","year":"2016","journal-title":"Case Rep. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ijscr.2013.11.014","article-title":"A giant right atrial villous myxoma with simultaneous pulmonary embolism","volume":"5","author":"Ay","year":"2014","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"111311","DOI":"10.1016\/j.ijscr.2025.111311","article-title":"A rare case of biatrial myxoma in an 11-year-old girl patient with thromboembolic stroke: A case report","volume":"131","author":"Laksmono","year":"2025","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"96","DOI":"10.59556\/japi.73.0865","article-title":"Biatrial Myxoma Twins with Acute Myocardial Infarction-A Malady of Rarities!","volume":"73","author":"Jain","year":"2025","journal-title":"J. Assoc. Physicians India"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"667","DOI":"10.2143\/AC.64.5.2042698","article-title":"Angina pectoris as first manifestation of a huge biatrial myxoma","volume":"64","author":"Alexiou","year":"2009","journal-title":"Acta Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.21037\/atm-20-6993","article-title":"Total thoracoscopic surgery for biatrial cardiac myxoma: A case report","volume":"8","author":"Tang","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"450","DOI":"10.4103\/aca.ACA_107_17","article-title":"Atrial myxomas causing severe left and right ventricular dysfunction","volume":"20","author":"Dixit","year":"2017","journal-title":"Ann. Card. Anaesth."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"890","DOI":"10.5761\/atcs.cr.13-00121","article-title":"Carney complex with biatrial cardiac myxoma","volume":"20","author":"Havrankova","year":"2014","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4103\/aca.ACA_71_20","article-title":"Role of transesophageal echocardiography in the recurrent biatrial myxoma of uncommon origin","volume":"25","author":"Munirathinam","year":"2022","journal-title":"Ann. Card. Anaesth."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/s11748-008-0244-9","article-title":"Intraseptal biatrial myxoma excised via the superior septal approach","volume":"56","author":"Totsugawa","year":"2008","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","article-title":"2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/j.athoracsur.2007.09.033","article-title":"Unusual case of two synchronous intracavitary primary cardiac tumors","volume":"85","author":"Jutley","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"839","DOI":"10.5761\/atcs.cr.12.02152","article-title":"Extensive resection and double-patch reconstruction for left atrial myxoma","volume":"20","author":"Morokuma","year":"2014","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_41","first-page":"51","article-title":"Large left atrial myxoma with severe mitral regurgitation: The inverted T-shaped biatrial incision revisited","volume":"33","author":"Davoli","year":"2006","journal-title":"Tex. Heart Inst. J."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Harpa, M.M., Oltean, S.F., Al Hussein, H., Anitei, D.E., Puscas, I.A., B\u0103nceu, C.M., Veres, M., Opri\u0219, D.R., Balau, R.A., and Suciu, H. (2024). Successful Treatment of Unilateral Pulmonary Edema as Minimally Invasive Mitral Valve Surgery Complication-Case Presentation. J. Clin. Med., 13.","DOI":"10.3390\/jcm13247654"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1177\/15569845241289132","article-title":"Long-Term Outcomes of Minimally Invasive Endoscopic Versus Sternotomy Surgical Resection of Primary Cardiac Tumors","volume":"19","author":"Aboelnazar","year":"2024","journal-title":"Innovations"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Harpa, M.M., Anitei, E.D., Ghiragosian, C., Calburean, P., Opris, D.R., Banceu, M.C., Arbanasi, E.M., Suciu, H., and Al Hussein, H. (2025). Endoscopic Mitral Surgery in Noonan Syndrome-Case Report and Considerations. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020583"},{"key":"ref_45","first-page":"85","article-title":"Multimodality imaging of biatrial myxomas in an asymptomatic patient","volume":"10","author":"Nishio","year":"2014","journal-title":"J. Cardiol. Cases"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Stoica, A.I., Harpa, M.M., Banceu, C.M., Ghiragosian, C., Opris, C.E., Al-Hussein, H., Al-Hussein, H., Flamind Oltean, S., Mezei, T., and Mares, R.G. (2022). A Rare Case of Undifferentiated Pleomorphic Cardiac Sarcoma with Inflammatory Pattern. Medicina, 58.","DOI":"10.3390\/medicina58081009"},{"key":"ref_47","first-page":"yty045","article-title":"Bi-atrial cardiac myxoma with glandular differentiation: A case report with detailed radiologic-pathologic correlation","volume":"2","author":"Flint","year":"2018","journal-title":"Eur. Heart J. Case Rep."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/4\/294\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:53:57Z","timestamp":1764690837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/4\/294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,30]]},"references-count":47,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medsci13040294"],"URL":"https:\/\/doi.org\/10.3390\/medsci13040294","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,30]]}}}