The American Heart Hospital Journal


tract and prolapsed into the pulmonary artery during systole, almost completely blocking the outflow tract at the maximum gradient 70mmHg (see Figure 1). The right ventricle was markedly dilatated and larger than the left ventricle. Moderate tricuspid regurgitation was also found. The calculated pulmonary artery systolic pressure was 40mmHg.


Magnetic resonance imaging (MRI) revealed that the left ventricle was compressed by the large right ventricle (maximum diameter was 53mm), which contained a huge nonhomogenic mass measuring 30x60x70mm rising from the basal interventricular septum and growing throughout the right ventricular outflow tract to the truncus pulmonalis (see Figure 2).


Multislice computed tomography (MSCT) confirmed the dilatation of the right ventricle and indicated a lobular, sharply delimited, relatively homogenous polypoid soft tissue structure within, which protruded into the infundibulum and almost blocked it. However, there were no significant changes in the coronary arteries (see Figure 3).


The patient immediately underwent surgery. Cardiopulmonary bypass was established using aortic and bicaval cannulas with moderate hypothermia. The right atrial approach did not allow sufficient space to excise the whole mass. Instead, right ventriculoctomy was performed and a large mass, weighing 57g and measuring 80x60x30mm was excised with the surrounding septal wall to prevent relapse (see Figure 4). The right ventricular septal wall was repaired with an autologous glutaraldehyde-treated pericardial patch. Histopathologic findings confirmed the diagnosis of myxoma (see Figure 5). Post-operative recovery was uneventful and there was no recurrence in the following six months.


Discussion


Cardiac myxomas are often found in the atria. About 75% of myxomas arise from the left atrium and 15–20% from the right atrium. Only 3–4% of all myxomas are detected in the left ventricle and the same proportion in the right. Symptoms depend on tumor size, mobility, and localization.1,3


In the majority of patients with myxoma


clinical presentation relates to obstruction of blood flow and embolic phenomena. Patients with right ventricular myxomas may present with symptoms and signs of inflow or outflow obstruction, syncope, embolism, and arrhythmia.3


In this patient, the large myxoma obstructed


the right ventricle outflow tract. She presented with exertional syncope, signs and symptoms of right heart


Winter 2010


failure, and auscultatory findings of pulmonary stenosis. Certain constitutional symptoms can occur irrespective of tumor localization, and dimension. These include: malaise, fever, erythematous rash, arthralgia, myalgia, weight loss, Raynould’s phenomena, anemia, and elevated CRP levels. The tumor may secrete IL-6, resulting in inflammatory and autoimmune manifestations.4


Myxomas localized in the Right Ventricular Myxoma Obstructing the Outflow Tract 119


Figure 1: 2D Transthoracic Echocardiography Showing Tumor Mass Filling Right Ventricle and Prolapsing into Pulmonary Artery During Systole


Case Report


TU = tumor mass; AP = pulmonary artery.


Figure 2: Magnetic Resonance Image Showing Tumor Mass Obstructing Right Ventricular Outflow Tract


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