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Page 4 of 4 Vessel Plus 2018;2:31 I http://dx.doi.org/10.20517/2574-1209.2018.58

5. Rare case of multiple right atrial myxomata with acute pulmonary thromboembolism: a
case report

Parin Chandrakant Sangoi, Ramkumar Rajaram, Vignesh Gomathinayagam, Ajit Mullasari

Department of Cardiology, Madras Medical Mission, Chennai 600037, India.

This is a case report of a 56-year-old morbidly obese female who was presented to our emergency room with
complaints of acute onset progressive breathlessness since 3 days (NYHA class IV) with presyncope and
palpitation but no history of chest pain. The patient was diagnosed with pulmonary thromboembolism with
IVC - RA thrombus 4 years back. During examination she was found to be morbidly obese, with presence of
skin tags and naevi in interscapular and left zygoma region. Her vitals were: HR 118/min, BP 100/70 mmHg
and SPO 85% in room air. Cardiopulmonary examination revealed good heart sounds with basal crepts.
2
ECG showed Sinus tachycardia (+). Echo revealed a pedunculated right atrial (RA) mass attached to the
lower intra atrial septum of size 2.9 cm × 1.5 cm protruding through the tricuspid valve in diastole . Another
mass of size 1 cm × 2 cm was seen in Right Atrium with pedicle attached near IVC-RA junction. The patient
also had severe Tricuspid Regurgitation with pulmonary hypertension. Further investigations revealed an
elevated D - Dimer and CT PA confirmed RA mass with acute pulmonary embolism involving both the
lungs. The patient was treated with low molecular weight heparin and follow-up echo showed decrease in
Pulmonary artery pressure with improvement in her symptoms. The presence of morbid obesity, cushin-
goid habitus, cutaneous skin tag in the left interscapular area, cutaneous neavi, multiple atrial myomata and
pulmonary embolism together steered us towards the possible diagnosis of Carney’s Complex. This case has
been presented because the right atrial mass produces a diagnostic dilemma with differential diagnosis be-
ing thrombus (type A&B), primary tumor of heart commonly myxomas, lipomas, sarcomas and metastatic
tumours. Hence it is important to differentiate the masses because treatment options and prognosis of each
lesion vary.

6. Lectin-like oxidized-LDL receptor as the anti-atherosclerosis vaccine candidate

Valentina Yurina

Brawijaya University, Malang 65145, Indonesia.

Cardiovascular disease remains the most burdening health problems worldwide. The disease accounts for
31.43% mortality globally. Some of the major risk factors for the disease are hypertension (33%), hypercholes-
terolemia (19%), overweight (56%), and current smoking (19%). Hypercholesterolemia indicated by the elevat-
ed low-density lipoprotein (LDL) cholesterol and its oxidized products, which unlike the LDL cholesterol, is
unrecognizable by its receptor. The oxidized LDL cholesterol (ox-LDL) is taken up by the scavenger receptors
in the endothelial cells and macrophages. Lectin-like ox-LDL receptor-1 (LOX-1) remains as the major ox-
LDL scavenger receptor in the endothelial cells. The LOX-1 participates in the early atherosclerosis phase by
inducing the endothelial dysfunction. However, in the late stage of atherosclerosis, LOX-1 also plays a role
in the smooth muscle cells apoptosis and foam cells formation. The LOX-1 expression is relatively low in the
basal level, hence its expression is enhanced by several clinical conditions, such as hypertension, diabetes,
obesity, atherosclerosis, and myocardial infarction. Several approaches demonstrated that the inhibition of
LOX-1 reduces the endothelial dysfunction and atherosclerosis development. These studies indicated that
LOX-1 inhibition is a promising candidate for atherosclerosis prevention. Our study demonstrated LOX-1 ef-
ficacy as the atherosclerosis vaccine candidate through DNA vaccination and subunit vaccination approach.