Right Ventricular Myxoma Simulating Pulmonic Stenosis

Abstract

MYXOMA of the heart is found in 0.02 to 0.1 per cent of autopsies, more frequently in the left than in the right atrium. [1][2][3] Myxoma originating in the ventricles is extremely rare: six cases of left ventricular4-7 and three of right ventricular origin8-'0 are recorded in the literature. In addition, two fibromas of the right and three thrombotic pseudotumors of the left ventricle have been described.8 11 The question whether myxomas are fundamentally different from organized and degenerated thrombi12, 13 will not be discussed. One left ventricular tumor has been successfully removed with the aid of cardiopulmonary bypass.5The following is a report of an intracavitary right ventricular myxoma; this appears to be the fourth case described and the first one treated surgically.Case Evidence of congestive heart failure was present at the last admission in January 1961 and was not controlled by strophanthin completely, as shown by the elevated diastolic pressure of the right ventricle at the third cardiac catheterization (table 1). This was performed preliminary to surgical intervention necessitated by the rapid progression of the circulatory failure; in contrast to the former results, the withdrawal curve demonstrated a sharp change of systolic pressure localized at or near the pulmonary valve. Thus the important question about the type of the stenosis, whether valvular or infundibular, was not settled satisfactorily; therefore it was decided to operate with the aid of extracorporeal circulation and hypothermia. Some days prior to operation an attack of exertional syncope with apnea and cardiac arrest occurred.Surgery was performed with the aid of the KayCross heart-lung machine. The outflow tract of the enlarged right ventricle was opened. A large tumor of myxomatous appearance was found obstructing almost completely the pulmonary orifice, protruding partly into the artery itself. The tumor was excised from its attachments to the ventricular wall and the semilunar valve and was entirely removed; it measured 6 by 4 by 3 cm. The ventricle was closed, and the extracorporeal circulation was discontinued after a total duration of 40 minutes. The patient awoke in the operating room and answered several questions; his mean arterial pressure was 75 mm. Hg, the electrocardiogram revealed atrioventricular dissociation.

Calcified right atrial mass: Report of a case and discussion of the differential diagnosis

“…As is usual in degenerative areas, minor calcification is common and bone formation is occasionally recorded (Gottsegen et al, 1963). Strouse (1938) first reported calcification in a tumour of 43 years' duration, but gross calcification such as was seen in our case is rare and appears to be relatively more common in right atrial than in left atrial myxomata.…”

“…Sudden death from tumour embolization of the pulmonary artery (Chiari, 1931, quoted by Prichard, 1951 Recurrent attacks of heart failure for 43 years (Strouse, 1938) Carcinoma of rectum and marked atherosclerosis also present Epilepsy and presumed bacterial endocarditis (Kendall and Symonds, 1952) Ebstein's anomaly (Coates and Drake, 1958) Fatigue and intermittent oedema (Campeti, Mahoney, and Yu, 1960) Severe congestive failure and weight loss of 21 lb (Catt, Denborough, Grigg, and Sloman, 1962) Polycythemia and raised platelet count regressing after removal of the tumour (Levinson and Kincaid, 1961) Constrictive pericarditis (Sannerstedt et al, 1962) Short attacks of abdominal pain with extreme nausea, breathlessness and faintness, loss of appetite, and weight loss of 41 lb (Barlow, Fuller, and Denny, 1962) Pulmonary tuberculosis and later constrictive pericarditis (Emmanuel and Lloyd, 1962) Tricuspid stenosis, apparently confirmed by cardiac catheterization (Morrissey, Campeti, Mahoney, and Yu, 1963) Pulmonary stenosis with pressure gradient measured across the pulmonary valve (Gottsegen, Wessely, Arvay, and Temesvari, 1963) This tumour actually arose in the right ventricle Recurrent pulmonary emboli with pulmonary hypertension (Heath and Mackinnon, 1964) Symptoms from the age of 26 years to the age of 63 years-thought to be tuberculous pericarditis (Oliver and Missen, 1966) Grawitz tumour of the kidney also present Diabetic, with Kimmelsteil Wilson syndrome (Stems, Eliot, Varco, and Edwards, 1966) Joint pains, anaemia, disordered proteins, and heart antibodies diagnosed as rheumatic disorder. (Currey, Mathews, and Robinson, 1967) Steatorrhoea clearing after removal of tumour (Webb-Peploe, Goodbody, Johnson, and McMillan, 1968) Pericardial friction rub mimicking acute pericarditis (Greenwood, 1968) Greenwood also mentions carcinoid and obstruction of the vena cava in the differential diagnosis.…”

Acquired pulmonary stenosis.

“…Myxomas ofthe pulmonary valve causing obstruction to right ventricular ejection have been reported by Blodorn (1955), Kishimoto andSakaibori (1959), Catton, Guntheroth, andReichenbach (1963), and Gottsegen et al (1963).…”

Mixoma ventricular direito gigante obstruindo via de saída do ventrículo direito

“…Intracardiac myxoma is the most common tumor of the heart, with an estimated incidence of 0.5 cases per million people per year [1]. Approximately 75% of these tumors arise from the left atrium and 18% from the right atrium.…”