Tricuspid valve obstruction and right heart failure due to a giant right atrial myxoma arising from the superior vena cava

Abstract

Myxomas are the most common primary cardiac tumors. The cardiac myxomas are mostly diagnosed within the atria, and only a few such tumors are reported to have arisen from atrioventricular valves or pulmonary vessels. The authors here present a case of 59-year-old Chinese woman who was hospitalized for exacerbating symptoms of tricuspid stenosis and right heart failure. Echocardiography revealed a giant right atrial myxoma arising from an extremely rare site, the anterior wall of the superior vena cava. With the aid of transesophageal echocardiography, the surgical resection was performed successfully with the patient achieving complete recovery.

Right atrial myxoma mimicking tricuspid stenosis

“…The main point that should be considered in right atrial myxoma surgery is placement of the caval cannula near the tumour after pump insertion in order not to cause intraoperative tumour embolisation during cannulation. Myxomas usually end with full recovery following careful surgical excision and the non-presence of traumatised mass or tumour inoculation 1. In our case, in order to minimise tumour embolisation risk, the inferior vena caval cannula was inserted after opening the right atrium following cardiac arrest considering the size and nearby placement to the inferior vena caval opening of the tumour.…”

“…Cardiac myxomas are located in the right atrium in 15–28% of cases, in the right ventricle in 8% of cases, in the left ventricle in 3–4% of cases and rarely in both atriums. In addition, myxomas can originate from mitral leaflets, aortic valves and pulmonary vessels in rare cases 1. Right-sided myxomas have a wider base on the atrium wall or septum compared with left-side myxomas.…”

Myxoma involving the pulmonary valve – A case report of an atypical cardiac tumor, treated using an unusual approach

“…The clinical presentation varies based on the location and extent of the disease. The presentation of myxoma can be categorized into 3 groups [ 2 , 3 , 7 , 8 ] :…”

“…The clinical presentation varies based on the location and extent of the disease. The presentation of myxoma can be categorized into 3 groups [2,3,7,8] : 1) Constitutional symptoms: fever, cough, fatigue, weight loss, loss of appetite, arthralgia, myalgia, Raynaud syndrome, and anemia. 2) Circulatory symptoms: symptoms related to obstruction of blood flow such as, syncope, dizziness, palpitations, shortness of breath, pulmonary edema, left/right heart failure.…”

“…Symptoms of atypical myxoma are mostly from blood flow obstruction (90%) versus constitutional (5%) or from embolization (5%) [9] . Reportedly, atypical myxomas can arise from: the right atrium usually at interatrial septum, anterior or posterior walls of left or right atrium, near the inferior vena cava (even within the suprahepatic portion), within the superior vena cava, left ventricle, aortic valve, right ventricle [1][2][3][4][5][6][7][8][9] . They rarely have a multicentric or biatrial origin [7,8,9] .…”