Right-left shunt caused by myxoma of the right atrium

We report on a 62-year-old female patient who developed central cyanosis due to a right atrial myxoma with right-to-left shunt.     

Synovial sarcoma in the right atrium and right ventricle

A metastatic synovial sarcoma in the right atrium and ventricle is described. A 36-year-old man was admitted to our hospital with generalized fatigue, dyspnoea, and precordial pain. Transthoracic echocardiography demonstrated a metastatic tumour in both the right atrium and right ventricle and revealed obstruction of the inflow tract of the right ventricle caused by a metastatic right atrial tumour. Thoracic computed tomography revealed a pleural-based paravertebral mass in the left intrathoracic cavity and multiple pulmonary nodules in both lungs. Cardiac surgery was performed for palliative treatment due to right cardiac failure and a risk of fatal embolization. The patient died 12 months after the cardiac surgery.     

Pseudotumor of the right atrium caused by hernia of the valve of Vieussens]

A round swelling was on the substraction films of the right side of the heart taken during angiocardiographic examination of a patient with mitral valve disease; this suggested a mass attached to the inter-atrial septum, and prolapsing into the auricle of the right atrium. Initial diagnsosi was of atrial thrombosis, but this was disproved at operation. An aneurysm of the membrane of the fossa ovalis was found, being caused by overstretching of the auricle of the left atrium under the increased pressure of the valve defect. The aneurysm was resected and the septum simply repositioned as part of the mitral valve replacement. A search of the literature shows how rare this disorder is, and that it should be reclassified with the abnormalities of the inter-atrial septum which are found only rarely in cases of mitral valve disease.     

Intracardiac shunt with hypoxemia caused by right ventricular dysfunction following pericardiocentesis

Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect. Pulmonary embolus, congenital heart disease and pericardial tamponade are well-recognized causes of right-to-left shunting. However, right-to-left shunting can also follow pericardiocentesis. A case of profound hypoxemia caused by right ventricular hypokinesis precipitated by pericardial tap is reported. This under-recognized entity can be responsible for significant morbidity in the critical care setting. The clinical presentation, natural history, diagnosis and treatment of hypoxemia caused by intracardiac shunt following pericardiocentesis are discussed.     

Right-to-left interatrial shunt with hypoxemia caused by a right atrial thrombus

A right-to-left shunt in the presence of normal pulmonary artery pressure is an unusual cause of hypoxemia in an adult who has a patent foramen ovale. We report a rare case of such a shunt-the result of a right atrial thrombus that formed in a hypercoagulable patient after placement of an indwelling central venous catheter for chemotherapy. In order to ascertain the nature of the right atrial mass and to decrease the risk of systemic embolization, the thrombus was surgically removed with the patient on cardiopulmonary bypass.     

Mural thrombi of the right atrium and acute bacterial endocarditis complicating a LeVeen shunt

A cirrhotic woman with a LeVeen shunt developed right atrial thrombi, acute bacterial endocarditis, and a major pulmonary embolus. The right atrial mural thrombi and resultant pulmonary emboli arose as a result of the placement of the venous end of the LeVeen shunt within the right atrium. This untoward event must be added to the growing list of complications associated with the placement of such catheters.     

Atrial flutter caused by migration of a superior vena cava stent into the right atrium

We describe the case of a patient presenting with an atrial flutter mechanically induced by a stent migration from the superior vena cava to the right atrium.     

A primary pericardial undifferentiated sarcoma invading the right atrium and superior vena cava

Primary undifferentiated cardiac sarcomas are rare. The literature demonstrated that 81% of primary cardiac undifferentiated sarcomas arose in the left atrium. We reported herein a case of 56-year-old male farmer with a primary pericardial undifferentiated sarcoma, which was revealed only on echocardiography but not computed tomography. The tumor, which invaded the right atrium and superior vena cava, was not completely resected.     

Use of blood oxygen partial pressure in the right atrium in the calculation of intrapulmonary shunt

In order to assess the usefulness of blood samples taken from the right atrium (RA) in the calculation of intrapulmonary shunt (Qs/Qt), we correlated the values of Qs/Qt obtained through RA sampling with those obtained form a simultaneous sample of blood from the pulmonary artery (PA). The study was done in six mongrel dogs (15 to 23 Kg) who were anesthetized and artificially ventilated. The Qs/Qt measurements were repeated at different levels of cardiac output (CO). Changes in CO were elicited by both mechanical (A-V fistula) and pharmacological (Hydralazine) means. Besides the Qs/Qt correlation we also correlated the oxygen-hemoglobin saturation (Sat %) and oxygen tension (PvO2) values between the two sites of mixed venous sampling. The correlations of the different parameters between RA and PA samples we obtained were as follows: Qs/Qt r = 0.93 (p less than 0.001); Sat % r = 0.87 (p less than 0.001); and for PvO2 r = 0.91 (p less than 0.001). The significant correlations of these parameters were maintained independent of the CO level. We conclude that in our model a sample of blood obtained from the RA is useful for the calculation of Qs/Qt.     

Unusual location of mural thrombi in the right atrium caused by pathological changes in the sinoatrial node

We present a post-mortem examination of two hearts in which we found organized mural thrombi attached to the right atrial endocardium in the recess called antrum atrii dextri. This region is a place where the sinus node is situated very close to the endocardium of right atrium. Any pathological process involving the node (inflammation, degeneration) may reach this part of endocardium by continuity, this in turn creates convenient conditions for mural thrombi formation. The first case--a 52-year old man who died of severe congestive heart failure caused by rheumatic disease with mitral and aortic stenosis. Atrial fibrillation had developed several years before his death. Apart from typical changes of mitral and aortic valves a post-mortem examination revealed an organized, globular thrombus in antrum atrii dextri. In the microscopical findings of the sino-atrial region the fatty degeneration of the sinus node with multiple mononuclear cell infiltration was the most striking feature. The sinus node artery was narrowed due to fibro-muscular dysplasia of its wall. The second case--a 74-years old man who suffered from arterial hypertension and chronic pyelonephritis with a history of heart infarct in the past. The ECG recording showed multifocal atrial rythm with variable P wave morphology and P-Q distance. At necropsy the whole heart was significantly enlarged with no scars or any other signs of healed infarct. The microscopical findings revealed the heart muscle to be infiltrated by amyloid deposits particularly apparent in the sinus node. Similar thrombus of 1.5 cm in diameter was found in antrum of the right atrium.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hemangio-endotheliosarcoma of the right atrium

In reporting a case of haemangiosarcoma of the right atrium the authors emphasize the problems encountered in the diagnosis of primary tumours of the heart. The patient was a 50-year old woman who complained of digestive disorders and palpitations. Physical examination showed signs of right heart failure associated with a systolic murmur on the right side of the sternum. ECG gave normal results. Echocardiography displayed a pouch with liquid ultrastructure communicating with the right atrium. Angiography confirmed the presence of a cavity with irregular borders communicating with the right atrium. Coronary arteriography showed an abnormal disorderly distribution of the right coronary artery branches with newly formed vessels extending toward the tumour. At exploratory thoracotomy a large liquid tumour was found which bled at the slightest touch and was attached to the mediastinum and the right pericardium. The pleura and the lung contained several nodules of the same venous colour as the mother tumour. Extemporaneous biopsy and pathological analysis were in favour of a haemangiosarcoma. The patient died a few days after the thoracotomy.     

Haemangioma of the right atrium revealed by cardiogenic shock

Intracardiac haemangioma is a very rare primary benign tumour. A 20 year old female patient, with no significant previous medical history, presented to the emergency department with cardiovascular collapse and vague abdominal pains, with no peripheral signs of cardiac failure. The electrocardiogram showed sinus rhythm with diffuse reploarisation disturbances. Chest radiography revealed cardiomegaly (cardiothoracic index of 0.67) with a right paracardial opacity. Abdominal ultrasound showed a moderate peritoneal effusion and transthoracic ultrasound showed a tumour occupying the right atrial cavity but sparing the interatrial septum. The patient underwent emergency open heart surgery for tumour resection and right atrial wall repair with autologous pericardium. Histology confirmed a haemangioma. Follow-up at one month was uneventful. The clinical, diagnostic and therapeutic features of this case are underlined.     

Varix of the right atrium.

A 68-year-old female patient was referred for the evaluation of an incidentally detected asymptomatic cardiac mass. Imaging studies showed a 3.0 x 2.4 cm, well circumscribed, round, cystic mass with a calcified nodule that was attached to the lower rim of the fossa ovalis in the right atrium. Under cardiopulmonary bypass, the right atrium was opened to reveal a well circumscribed, dark bluish, pedunculated mass. Histologically, the specimen was a unilocular cyst lined by flattened endothelium, with peripheral fibrin clots and dystrophic calcification of the wall. Immunohistochemical staining of the lining cells was positive for cluster designation 34, which represents hematopoietic progenitor cell antigen. The final pathologic diagnosis was compatible with varix of the heart, which should be considered for a cystic mass with a calcified nodule located in the right atrium, near the lower rim of the fossa ovalis.