Rare primary left atrial paraganglioma resected after preoperative coronary embolization: a case report

Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal paraganglia. Primary cardiac paragangliomas (PCPs) are an exceedingly rare subset, most commonly originating in the left atrium. A 23-year-old male with episodic chest pain and severe hypertension (210/140 mmHg) was found to have a primary left atrial paraganglioma. Preoperative selective angiography and embolization of tumor-feeding vessels were performed. After biochemical confirmation of stabilized plasma catecholamine levels, curative surgical resection was conducted under cardiopulmonary bypass. The patient was extubated on postoperative day 2 and discharged on day 9. The diagnosis and management of cardiac paragangliomas remain challenging. In this case, we adopted a combined approach of preoperative embolization and serial plasma catecholamine monitoring, deferring surgery until catecholamine levels stabilized—a strategy that differed from conventional direct resection. The observed transient catecholamine surge after embolization highlights the critical need for perioperative vigilance. Surgical resection remains the curative cornerstone, and given the high recurrence risk, lifelong biochemical and imaging surveillance is essential.