Case Report


Am Heart Hosp J. 2010;8(2):118–121


Right Ventricular Myxoma Obstructing the Outflow Tract


Branislava Ivanovic, MD, PhD, Marijana Tadic, MD, Danica Matic, PhD and Dragan Simic, PhD


Cardiac myxomas are benign tumors of endocardial origin. Symptoms might mimic heart disease as well as infectious disease, immunodeficiency, and malignant processes. We present the case of a 59-year-old female patient with a large right ventricular myxoma that was connected to the basal interventricular septum. Movement in systole provoked the obstruction of the right ventricular outflow tract. She presented clinically with syncope, systolic murmur, and signs of right heart failure. The diagnosis of the right ventricular tumor was based on 2D echocardiography, magnetic resonance, and multislice computed tomography findings. Emergency surgical excision of the myxoma was necessary to prevent embolism and sudden death.


P


rimary tumors of the heart are rare, with an incidence of 0.0017–0.19% in unselected autopsy series.1


Three-quarters of primary heart tumors


are benign. Approximately half of all cardiac tumors are myxomas, which occur in 0.5 in a million people each year.2


Although these tumors are histologically benign,


they are potentially fatal because of the associated risk of embolization and intracardiac obstruction.


We report a case of a 59-year-old female with a large myxoma of the right ventricle that caused obstruction of the right ventricular outflow tract.


Case Report


A 59-year-old Caucasian female was hospitalized because of syncope on exertion. Dyspnea on exertion had appeared four months before and became more intensive about 10 days prior to admission. A month before hospitalization, pretibial edema had appeared.


The patient had no personal or familial medical history of cardiac disease or Carney syndrome. On examination her blood pressure was 110/70mmHg, her heart rate was 92 beats per minute, and her temperature was normal. The patient was cyanotic with a plethoric face and jugular


vein distension. Auscultation revealed a regular heart beat, but a diminished second sound with 3/6 holosystolic ejection murmur on the left upper sternal border. There was no change in the murmur with respiration and position. The lungs were clear, the liver was 3cm palpated in the midclavicular line, and peripheral edema was evident. The patient had no neuroendocrine clinical signs or skin problems.


Results of routine blood tests were normal apart from an erythrocyte sedimentation rate of 41mm/h and raised C-reactive protein (CRP) levels (24mg/l). Blood gases were within normal ranges as were tumor marker levels and levels of interleukin 6 (IL-6).


Chest X-rays in the prone position showed an enlarged heart and bilateral reduction in transparency of the lung parenchyma in the lower third of the lungs.


An electrocardiogram showed sinus rhythm with right bundle branch block. 2D transthoracic echocardiography (TTE) revealed an abnormally large, peduncular, solid mass with an irregular surface in the right ventricle, which originated from the basal interventricular septum progressed through the right ventricle outflow


• Clinical Centre of Serbia, Clinic for Cardiology, Koste Todorovic 8, 11000 Belgrade, Serbia


• Correspondence: Branislava Ivanovic, MD, PhD, Associate Professor, Clinic for Cardiology, Clinical Centre of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia. E: lole@scnet.rs


118 Right Ventricular Myxoma Obstructing the Outflow Tract Winter 2010


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