Unusual case of Large Right Atrial mass
V, Bharath1; Hote, Milind P.1
1 – Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, New Delhi, India
Corresponding Author: V, Bharath
Department of Cardiothoracic and Vascular Surgery, All India Institute
of Medical Sciences, New Delhi, India
ABSTRACT
A 57-year female presented to emergency with features of right heart
failure. On evaluation, she was found to have a large mass completely
occupying right atrium and protruding into right ventricle through
tricuspid valve. Here we present the 3D reconstruction images and
intra-operative images of the RA mass.
Keywords: right atrial mass; myxoma; benign tumor
Introduction
Myxoma is the most common benign tumor of heart. Usually myxoma is soft,
lobulated, friable mass. Its seen commonly in left atrium, right atrium
and less frequently in ventricles. Due to its friable nature, it can
easily embolize distally. It is usually diagnosed when person develops
heart failure symptoms or embolic phenomenon. Treatment includes
complete excision with prevention of distal embolization.
Case details
A female aged 57 years presented to emergency with shortness of breath
and generalized body swelling for 2 months. On evaluation, she was found
to have large mass occupying whole of right atrium and protruding into
right ventricle through tricuspid valve.
She underwent Computed tomography (CT) angiography for evaluation of
coronaries and to rule out distal embolization (Figure 1).
Patient was planned for emergency mass excision. Once intubated and on
mechanical ventilation with arterial and central venous lines secured,
she was placed in supine position, painted and draped.
Midline sternotomy was performed and pericardial opened vertically
(Figure 2).
Large right atrial could be seen. Since mass was not involving Superior
and Inferior vena cava (SVC and IVC), Central cannulation was performed
and cardiopulmonary bypass was establised. Right atrium was opened after
cross clamping aorta and pulmonary artery and arresting the heart in
diastole with cold blood cardioplegia.
Just as the right atrium was incised, mass was seen completely occupying
it and bulging out (Figure 3 and 4).
Mass was gently delivered from right ventricle into right atrium through
tricuspid valve and lifted off its attachment from lateral wall of right
atrium. Right ventricle was thorougly checked for embolic mass and
thorougly washed with cold saline. Tricuspid patency was confirmed with
saline test and trans-esophageal echocardiography.
Right atrium and closed and patient came off bypass and routine
decannulation and closure followed. Figure 5 shows measurements of the
mass.
Histopathological analysis revealed the mass to be myxoma with
hemorrhagic areas within.
Discussion
Myxoma can present as a solid, globular mass in atrium. Routine
technique of its extraction should be followed with care taken to
prevent embolisation.
Conflict of Interest : None
Funding : None
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Clinical trial registration : N/A