Right atrial myxoma complicated with pulmonary embolism

Abstract

A 25-year-old woman was admitted to our hospital with chest pain and dyspnea, and was diagnosed as having a right atrial myxoma complicated with pulmonary embolism. An emergency operation was performed with cardiopulmonary bypass. A papillary pedunculated tumor was found having a narrow-based attachment to the free atrial wall. After the tumor was carefully removed together with the atrial wall around the attachment, pulmonary embolectomy was performed. Several fragments of the tumor were removed, and sufficient back-flow from the pulmonary artery was established. The postoperative course was uneventful. However, a non-perfused area was observed in the left lower lung on pulmonary hemodynamic scintigraphy at 3 months after the operation. Long-term observation is required due to the high risk for metastasis and recurrence, and further surgical treatment remains the most appropriate treatment option. A second operation may be needed to prevent progression in complications.

The Challenge Presented by Right Atrial Myxoma

“…They may consequently account for certain unexplained sudden deaths beyond medical help, and may not be disclosed until severe complications develop. Pulmonary embolism from fragments originating from the tumor mass is one such potentially fatal complication, accompanied by pleuritic chest pain and dyspnea [3,55,56,68]. More rarely, the tumor mass, by blocking the right atrioventricular ostium [10] or the vena cava, may lead to a Budd-Chiari syndrome with acute abdominal pain [46] or even syncope [74].…”

“…In addition to meticulous pulmonary embolectomy, intraoperative establishment of sufficient backflow from the pulmonary artery is likewise crucial [55].…”

Sudden death due to acute pulmonary embolism from asymptomatic right atrial myxoma

“…In most clinical reports, a right atrial myxoma gives rise to signs of cardiac obstruction with dyspnea, syncope and general edema. 1,[9][10][11] These symptoms are related in part to the size of the tumor. There are no symptoms with a small tumor, but large tumors can cause an obstruction of the tricuspid valve and right atrium, resulting in right sided heart failure.…”

The management of fast-track cardiac anesthesia in a patient with right atrial myxoma

“…The literature contains only a few reports concerning these complications and their anesthetic management. [1,2] In our case report, we discuss a patient who had right atrial myxoma complicated by pulmonary embolism and infective endocarditis. He was treated surgically with a fast-track cardiac anesthesia (FTCA) protocol.…”