Coincident large left atrial myxoma and severe three-vessel coronary artery disease: single-stage resection with CABG: a case report

BACKGROUND: Cardiac myxoma, the most common primary cardiac tumor, can present with symptoms that overlap with coronary artery disease (CAD), creating a diagnostic challenge, particularly in older patients with cardiovascular risk factors. CASE PRESENTATION: We report a case of a 67-year-old Arab woman with long-standing hypertension and type 2 diabetes mellitus, who presented with typical exertional angina. A transthoracic echocardiogram revealed a large left atrial mass consistent with a myxoma. Subsequent coronary angiography confirmed severe three-vessel CAD. Laboratory findings were notable for mild anemia and significantly elevated inflammatory markers, which had normalized by the time of surgery. The patient underwent a successful single-stage operation consisting of the complete surgical excision of the atrial myxoma and coronary artery bypass grafting. Histopathological analysis confirmed the diagnosis of a benign cardiac myxoma. Her postoperative recovery was uneventful, and she was discharged in good condition, with excellent clinical and echocardiographic results at follow-up. CONCLUSION: This case highlights the importance of maintaining a high index of suspicion for coexisting CAD in elderly patients diagnosed with cardiac myxoma. Preoperative coronary angiography is essential in this demographic to facilitate accurate diagnosis and guide the surgical strategy, for which a combined, single-stage operation is widely considered the most appropriate approach.