Prolapsing right atrial myxoma.

Echocardiography was of great value in establishing the correct diagnosis in a patient with symptoms of congestive heart failure due to a prolapsing right atrial myxoma. The movement of the tumor into the right ventricle through the atrioventricular orifice during diastole was identified by the echocardiogram and confirmed by angiography and direct observations during surgery. The indicator dilution curve also showed abnormal hemodynamic features simulating tricuspid incompetence, in relation to the movement of the tumor.     

Massive right atrial myxoma

Right atrial myxomas are uncommon and are often detected incidentally in asymptomatic individuals. We describe a case of a massive right atrial myxoma that was suspected following an abnormal right heart border on a chest X-ray and an abnormal 12 lead electrocardiogram.     

Angiographic visualization of 'tumour vascularity' in atrial myxoma

Nine patients with atrial myxoma in whom selective coronary arteriography had been performed were studied. The angiographic sign of 'tumour vascularity' was found to be present in three patients with highly vascularized atrial myxoma. The clinical significance of the angiographic sign is unknown although highly vascularized myxomata appear to have a greater propensity to bleeding into the tumour, resulting in an acute worsening of clinical symptoms. The angiographic sign of 'tumour vascularity' is not specific but useful to complement the diagnosis of an atrial myxoma. The indication for selective coronary arteriography in patients with atrial myxoma remains the detection of coronary artery disease, thus concomitant coronary artery bypass surgery could be planned preoperatively.     

Lentiginosis and right atrial myxoma

A right atrial myxoma was detected by cross-sectional echocardiographyin a 21-year-old woman with cutaneous lentiginosis. The lentigineswere present mainly on the right side of the trunk.     

Surgical treatment of right atrial myxoma

A 51-year-old man with a large right atrial myxoma underwent emergency surgical resection in our institute. The diagnosis of such tumors can be difficult, and their resection presents difficulties for the placement of the venous cannulae. We used a single cannula in the superior vena cava until fibrillation, and then we inserted a cannula into the inferior vena cava. We present this technique as a method of avoiding embolization.     

An unusual case of large right atrial myxoma.

A case of right atrial myxoma is described. The patient had vague and variable symptoms and it was not until five years after first presentation that she had developed clinical and electrocardiographic evidence of right atrial hypertrophy, and angiocardiographic evidence of a fist-sized myxoma which was subsequently removed surgically.     

Delay in diagnosis of right atrial myxoma

Clinical, echocardiographic, and nuclear angiographic findings in a 51-year-old woman who presented with a history of dyspnea are discussed. Initial echocardiography revealed no abnormality. However, a subsequent radionuclide angiogram revealed a filling defect on the right side of the heart. This represented a right atrial myxoma. Radionuclide angiography can provide a useful noninvasive tool in the diagnosis of intracardiac tumors when echocardiography has not been helpful.     

Massive right atrial myxoma presenting with syncope

A 65-year-old man presented to the emergency room following an episode of syncope. His vital signs and physical examination were unremarkable. A chest X-ray and an ECG were also normal. He was admitted to the hospital for further work-up. A computed tomography scan of his brain did not reveal any evidence of stroke, hemorrhage, or mass effect. A transesophageal echocardiogram, however, revealed tricuspid regurgitation and a right atrial mass with finger-like projections, which appeared to originate from the tricuspid valve. Left heart catheterization was performed, showing a 99% proximal right coronary artery stenosis. The patient was scheduled to undergo atrial mass resection, tricuspid valve annuloplasty, and coronary bypass. During the procedure, a large myxoma was found to be adherent to the right side of the atrial septum, adjacent to the fossa ovalis. The mass was friable and was attached to the endocardium by a pedicle. Following resection of the atrial mass and tricuspid valve annuloplasty, a single saphenous vein graft bypass to the right coronary artery was performed. The patient's postoperative course was unremarkable and he was discharged home on postoperative day 6.     

Massive right atrial myxoma causing exertional dyspnoea

Metastatic tumours are the commonest cardiac tumours being foundin 1–3% of patients dying of cancer while primary tumoursare unusual and have an incidence of 0.02–0.5%. The majority(80%) of all primary cardiac tumours are benign with myxomasaccounting for 50%. Myxomas arising from the right atrium areuncommon. We present the case of a 39-year-old female with a 4-month historyof progressive exertional dyspnoea accompanied by symptoms ofpalpitations and presyncope. Transthoracic echocardiographyshowed an extremely large right atrial myxoma prolapsing intothe right ventricle and obstructing the tricuspid valve. Wedemonstrate how intraoperative transoesophageal echocardiography,prior to sternotomy, was useful in providing information aboutthe myxoma which clearly displayed its attachment and anatomicalrelationship in the planning of the ‘safe’ surgicalexcision.     

Long-term severe pulmonary hypertension associated with right atrial myxoma.

An 18-year-old black woman presented with marginally compensated right heart failure, severe pulmonary hypertension, tricuspid incompetence, and right atrial myxoma. Catheterization suggested a substantial reactive component to her P-HTN, especially to nifedipine. Initial management consisted of excision of two right atrial myxomas and tricuspid annuloplasty, and postdischarge management with nifedipine, 30 mg four times daily. Emergency pulmonary thromboendarterectomy was required two weeks later for acute cor pulmonale. It is suggested that concomitant procedures are mandatory in this setting because of the otherwise accelerated adverse pathophysiology of obliterative pulmonary vascular obstructive disease.     

Prolapsing right atrial myxoma: clinical and heamodynamic considerations.

A 22-year-old woman with a right atrial myxoma prolapsing to the right ventricle is described. The haemodynamic findings were similar to those of cases of prolapsing myxoma of the left atrium; a notching on the ascending limb of the right ventricular pressure curve, and an initial negative, irregular deflection on the pulmonary artery pressure curve with a pronounced rise in the mean right atrial pressure (18 mmHg) were found. On deep inspiration there was a significant deepening of the y descent from 12 mmHg to 2 mmHg, indicating a changing, dynamic obstruction of the right ventricle inflow tract. These haemodynamic features can be helpful in the diagnosis of prolapsing right atrial myxoma.     

Detection of atypical right atrial myxoma by echocardiography

Atrial myxomas are the most common primary cardiac tumors. They are commonly found in the atria and are attached to the interatrial septum. We report a case of a right atrial cardiac myxoma in a 47-year-old woman who presented with fatigue, right-sided chest pain, and a syncopal episode. Echocardiography demonstrated an atypical attachment of the myxoma to the free wall of the right atrium. The features of cardiac myxoma and the role of echocardiography in the diagnosis and treatment of cardiac myxomas are also discussed.     

Detection of right atrial myxoma by coronary cinearteriography

During routine coronary cinearteriography, a large, right atrial myxoma was detected in a patient with angina pectoris. It was clinically unsuspected and was found at surgery to extend partially into the left atrium.     

A giant right atrial myxoma: Case report

Right atrial myxomas have rarely been reported. The authors describe a giant hourglass-shaped atrial myxoma consisting of three lobes; one of them had protruded into the right ventricle. Its size was 18×7×5 cm and weight was 170 g. The authors were not able to find another myxoma as big as this one in the literature, so they are reporting it. They review and discuss the literature involving the subject.