A Giant Right Atrial Myxoma Traverses through a Patent Foramen Ovale, Combined with Coronary Artery Bypass Grafting: A Case Report

Articles in Press

Document Type : Case Report

Authors

1 Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

2 Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

10.22038/jctm.2025.85873.1485

Abstract

Cardiac myxoma is the most common primary heart tumor in adults, although it is rare and typically occurs in the left atrium. While this tumor is benign, immediate surgical resection is necessary due to the potential risks of embolism and stroke. We reported a rare case of a right atrial myxoma accompanied by a patent foramen ovale (PFO), pulmonary embolism, inferior vena cava (IVC) web, and coronary artery occlusion, for which the patient underwent surgery. The patient was a 66-year-old female with a history of percutaneous coronary intervention (PCI) two years prior. She arrived at the hospital experiencing severe dyspnea. Her heart rhythm was atrial fibrillation, and there was no report of polycythemia. Additionally, the patient's troponin I level was negative. Angiography was performed, confirming the presence of coronary artery disease (CAD). The echocardiography performed on the patient revealed a large atrial myxoma, along with a PFO and an IVC web. Following surgery, the patient was transferred to the ICU in stable condition. Postoperative histopathology confirmed the presence of a myxoma. A follow-up echocardiography showed that all of the patient's issues had been resolved, and the size of the right atrium had decreased. The patient was discharged after seven days. Due to multiple reported cases of cardiac myxoma after ablation, and considering our patient's history of PCI two years prior, it is advisable to conduct echocardiography following any cardiac intervention. Documenting medical history, and interventions performed on patients, along with their consequences, significantly contributes to the timely diagnosis and treatment of this disease.

Keywords

References

  1. Tay LS, Chan CH, Chen X. Anaesthesia Management of Laparoscopic Subtotal Gastrectomy in a Patient With Atrial Myxoma: A Case Report. Cureus. 2024 Sep 25;16(9).
  2. Damián-Flores H, Torres-Sosa MJ. Primary cardiac tumors. Left atrial myxoma. Anesthetic management. Revista medica del Instituto Mexicano del Seguro Social. 2024 Mar 4;62(2):1-5.
  3. Arruda MV, Braile DM, Joaquim MR, Soares MJ, Alves RH. Resection of left ventricular myxoma after embolic stroke. Brazilian Journal of Cardiovascular Surgery. 2008;23:578-80.
  4. Romero ME, Sato Y, Mori M, Virmani R. Tumors of the cardiovascular system: heart and blood vessels. InCardiovascular Pathology 2022 Jan 1 (pp. 799-844). Academic Press.
  5. Okan T, Babliak O, Agarwal K, Kuzyk Y, Lanka SP, Iskander B, et al. Asymptomatic left atrial myxoma treated with minimally invasive surgical approach. Cureus. 2021 Oct 2;13(10).
  6. Maldonado-Suarez J, Santiago VD, Molina-Lopez VH. Large Right Atrial Myxoma: A Rare Presentation. Cureus. 2024 Feb 15;16(2).
  7. Rabiee Rad M, Ghasempour Dabaghi G, Darouei B, Amani-Beni R, Zare MM, Shirin F, et al. Clinical and laboratory manifestations, ECG findings, and outcomes of right atrial myxoma: A systematic review of cases reported worldwide. The Egyptian Heart Journal. 2024 Sep 12;76(1):125.
  8. Griborio-Guzman AG, Aseyev OI, Shah H, Sadreddini M. Cardiac myxomas: clinical presentation, diagnosis and management. Heart. 2022 Jun 1;108(11):827-33.
  9. Shah AH, Horlick EM, Kass M, Carroll JD, Krasuski RA. The pathophysiology of patent foramen ovale and its related complications. American Heart Journal. 2024 Aug 10.
  10. Zhu J, Chen A, Zhu L, Li Y, Jiang Z, Ni D, et al. Right Atrial Septal In Situ Microthrombus: A Potential Novel Cause of Patent Foramen Ovale‐Associated Stroke. Journal of the American Heart Association. 2024 Nov 19;13(22):e035838.
  11. Saha D, Sinha L, Samal S, Sharma P, Naqvi SE, Geelani MA. An unusual presentation of right atrial myxoma: a case report. Oman Medical Journal. 2023 Jan 31;38(1):e466.
  12. Qi W, Yu XL, Yang DX, Hu XK, Chen JP, Yao YT, et al. Anesthetic management of patients undergoing cardiac myxoma resection: a single-center retrospective analysis. Frontiers in Cardiovascular Medicine. 2023 Apr 27;10:1126822.
  13. Wada T, Hamamoto H, Miyamoto S. Giant right atrial tumor following catheter ablation. General Thoracic and Cardiovascular Surgery Cases. 2024 Feb 27;3(1):15.
  14. Jing G, Ligang L, Wei Z, Yani L. A giant left atrial myxoma transits across patent foramen ovale a PFO mimicking biatrial myxoma: a case report. European Heart Journal-Case Reports. 2024 May;8(5):ytae218.
  15. Hamid K, Sathyanarayanan SP, Hoerschgen K, Ali M, John CY. Right atrial thrombus presenting as platypnea-orthodeoxia secondary to reverse lutembacher syndrome: a case report. Cureus. 2022 Jul 11;14(7).
Journal of Cardio-Thoracic Medicine

Articles in Press, Accepted Manuscript
Available Online from 18 February 2025

Files

Share

How to cite

Statistics