Biatrial Cardiac Myxomas: A Unique Presentation with Acute Limb Ischemia and Reversal of Left Ventricular Dysfunction after Excision

Abstract Cardiac myxomas are the most common primary benign cardiac tumors, predominantly located in the left atrium. Biatrial myxomas are exceedingly rare, accounting for <2.5% of all myxoma cases. This case highlights a unique presentation of biatrial myxoma associated with acute limb ischemia and severe left ventricular dysfunction (LVD), with complete resolution following surgical excision. A 35-year-old female presented with acute left lower limb ischemia. Initial management included an emergency embolectomy, which restored limb perfusion. Further evaluation revealed biatrial masses prolapsing into the respective ventricles, accompanied by severe global LVD (ejection fraction 25%). Cardiac magnetic resonance imaging confirmed the masses as biatrial myxomas originating from the interatrial septum. The patient underwent successful surgical excision of the tumors, with histopathology confirming cardiac myxoma. Postoperative recovery was uneventful, with normalization of ventricular function and resolution of symptoms. Biatrial myxomas are exceptionally rare, with fewer than 45 cases reported globally. This case is notable for its combination of biatrial involvement, acute limb ischemia, and reversible severe LVD. Proposed mechanisms for LVD include cytokine-mediated myocardial depression and mechanical interference. The case underscores the importance of comprehensive imaging for diagnosis and timely surgical intervention. This report highlights the rarity and clinical complexity of biatrial myxomas. Early recognition, multimodal imaging, and prompt surgical management are essential for favorable outcomes, as demonstrated by the dramatic recovery in our patient.