Right ventricular myxoma obstructing the right ventricular outflow tract: a case report

Abstract

IntroductionPrimary cardiac tumors are uncommon during infancy and childhood. Myxomas originating from the right ventricle are even less common in pediatric patients.Case presentationHere we describe a case of an 11-year-old Tunisian boy who was referred for syncope. Transthoracic echocardiography revealed a large mobile mass attached to his right ventricle, obstructing his right ventricular outflow tract. Complete surgical excision of the mass with preservation of the pulmonary valve was performed. The diagnosis of myxoma was histologically confirmed.ConclusionCardiac myxomas located in the right ventricular outflow tract are rare and can present unusual diagnostic and therapeutic challenges.

Pulmonary Embolism Following Incomplete Surgical Resection of a Right Ventricular Myxoma: A Case Report and Review of the Literature

“…Most of the rest occur in the right atrium. RV myxomas were reported in just 3–4% of cardiac myxoma cases [3]. Myxomas range between 1 and 15 cm in diameter weighing between 15 and 180 g [21].…”

“…Most myxomas arise in the left atrium. Those located in the right ventricle are rare [3], and they are of a particular concern because of the risk of pulmonary tumor embolism. Right ventricular (RV) myxomas accompanied by pulmonary embolism (PE) are reported only in a limited number of studies in the medical literature [4–14].…”

Right Ventricular Myxoma

“…2,3,5 RV myxomas usually cause symptoms resulting from RVV obstruction, and symptoms of syncope, pulmonary embolism and sudden death may occur. 6,7 In the literature, there are few reports of isolated cases of RV myxomas, in most cases occurring with RVOT obstruction. Seong et al 7 reported the case of a patient with a very similar condition to ours, where a large myxoma originated in the RV, did not obstruct the RVOT and presented dense adhesion to the tricuspid valve leaflet and, as in our case, surgery also included tricuspid valve repair.…”

“…Imaging methods, particularly echocardiography, are the tests of choice for diagnosis, 7 with excellent sensitivity (95%) in detecting the tumor, which may reach 100% when associated with transesophageal echocardiography. 3,6 Schneider et al…”

“…They are preferentially located in the left atrium, with an incidence of 70 to 80%, 18% in the right atrium and, more rarely, from 2 to 5% in the ventricles, or multicentric. [3][4][5][6] Myxomas that originate in the right ventricle (RV) and obstruct the right ventricular outflow tract (RVOT) are extremely rare in children. 5 Patients present at least one of the characteristics of the classical triad described, which includes constitutional, embolic or obstructive symptoms.…”