Giant myxoma causing right ventricular outflow tract obstruction

Division of Cardiothoracic Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine (Impact Factor: 0.87). 06/2011; 17(3):242-4.
Source: PubMed


Atrial cardiac myxoma is the most common benign cardiac tumour. Atrial myxoma most commonly arises from the left atrium and, less frequently, from the right atrium or both ventricles. Cardiac myxoma arising from the tricuspid valve is rare. These tumours can present with right heart failure as a result of right ventricular outflow tract obstruction. A high index of suspicion and appropriate investigations are necessary for making the correct diagnosis. Fatal complications such as embolisation and obstruction of the outflow tract and other intracardiac structures make prompt surgical intervention necessary. We report on a patient with a rare type of giant myxoma arising from the tricuspid valve. He underwent successful operation with en-bloc removal of the tumour, while preserving the integrity of the tricuspid valve.

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    • "Atrial myxoma is the most common benign cardiac tumor [1]. Primary cardiac tumors are extremely rare with a reported incidence ranging from 0.0017% to 0.28% at the time of autopsy [2,3]. "
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    ABSTRACT: Myxomas arising from the eustachian valve are exceedingly rare. A 72-year-old Jamaican-Chinese woman was evaluated for worsening dyspnea. The 2-dimensional and real time 3-dimensional transesophageal echocardiogram showed a 75 mm length × 44 mm width, multilobulated, mobile mass arising from the eustachian valve occupying the entire right atrial and right ventricular cavities extending into the coronary sinus, right ventricular outflow tract, and proximal inferior vena cava. The patient underwent successful resection of the mass and replacement of the tricuspid valve. Histopathologic examination confirmed the diagnosis of atrial myxoma. This is the largest myxoma found on a Eustachian valve.
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    ABSTRACT: Primary cardiac tumors are quite uncommon and myxomas constitute the major proportion among these masses. The present study summarizes our 20-year clinical experience with surgical resection of intracardiac myxomas. Between January 1990 and December 2007, 98 patients (42 males, mean age 60.4±4.1 years) underwent complete excision of primary intracardiac myxoma. In 84 patients the origin site of the tumor was located in the left atrium, and the most common implant site was the interatrial septum. The most common symptom at admission was dyspnea, while systemic embolization was observed in 37 patients. Preoperative diagnosis was established in all patients by transthoracic echocardiography. All patients were operated through median sternotomy. Ninety-five patients (97%) survived the operation. Mean tumor dimension was 2.7±1.3 cm in largest diameter. According to the St. John Sutton classification (St. John Sutton MG, Mercier LA, Giuliani ER, et al. Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Pro 1980;55:371-6), solid tumors were detected in 43 patients (44%), while a papillary myxoma was found in 55 patients (56%). The follow-up was 100% complete, and the mean time to last follow-up was 98±60 months. Of the 95 survivors, 3 patients (3%) died at a mean follow-up of 72±45 months after surgery. Actuarial survival was 98%, 98%, and 89% at 5, 10, and 15 years, respectively. One patient operated for left atrial myxoma resection showed a recurrence 68 months after the first surgery. Although cardiac myxomas carry the risk of severe systemic and cardiac symptoms, prompt surgical excision gives excellent early and long-term results.
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