Preoperative exclusion of significant coronary artery disease by 64-slice CT coronary angiography in a patient with a left atrial myxoma

This chapter presents a case of a 49-year-old man without any significant past medical history presented to the emergency department with complaints of diploplia, paresthesias in both arms, vertigo, tinnitus in the right ear, and dysarthria. Physical examination was unremarkable. A computed tomographic (CT) scan of the head was normal. These symptoms resolved within several hours, consistent with a transient ischemic attack. Magnetic resonance imaging of the brain revealed acute infarcts in the left cerebellar hemisphere and in the right occipital lobe, suggesting a thromboembolic source. As the patient was considered to have a very low risk for the presence of significant arterial narrowing, he underwent a 64-slice cardiac CT scan rather than invasive coronary angiography. The left atrial mass was also well visualized on both the axial slices and also with three-dimensional imaging. The case demonstrates how, in the future, routine invasive coronary angiography may not be necessary as part of the workup for noncoronary cardiac surgery.