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a macroscopic appearance of right ventricualr tumor (9.5 cm * 5.0 cm) showed a multinodular, pedicled, kermesinus mass with clear border; b the mass consisted of areas of stellate cells surrounded by abundant, loose, myxoid stroma microscopically
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Background
Myxoma is an uncommon disease and its symptoms vary greatly depending on size, location and mobility. Right-sided myxoma, especially right ventricular myxoma, is much rarer, and the symptoms are alien and uncharacteristic. The lack of understandings poses challenges to prompt diagnosis and timely treatment.
Case presentation
A 44-year-o...
Citations
... Another case study reported resection of a right ventricular myxoma of 9.5 × 5.0 cm. However, resection of a ventricular tumor combined with clearance of a pulmonary embolism has not often been reported [6]. Pulmonary embolectomy has rarely been used to treat acute right ventricle dysfunction caused by a pulmonary embolism. ...
A 33-year male patient presented with a 6-month history of cough and shortness of breath upon physical activity. Echocardiography demonstrated right ventricular space-occupying lesions. Contrast-enhanced computed tomography of the chest showed multiple emboli in the pulmonary artery and its branches. Right ventricle tumor (myxoma) resection, tricuspid valve replacement, and clearance of the pulmonary artery thrombus were performed under cardiopulmonary bypass. Minimally invasive forceps and balloon urinary catheters were used to clear the thrombus. Clearance was confirmed by direct visualization using a choledochoscope. The patient recovered well and was discharged. The patient was prescribed oral warfarin 3 mg/day, and the international normalized ratio for prothrombin time was maintained between 2.0 and 3.0. Pre-discharge echocardiogram showed no lesion in the right ventricle or pulmonary arteries. The 6-month follow-up echocardiography indicated that the tricuspid valve was functioning well and showed no thrombus in the pulmonary artery.
... Most of the cardiac myxomas are located in the left atrium (75-85%) followed by the right atrium (15-20%). Only about 2.5-4% of cardiac myxomas originate from ventricular chambers [4][5][6][7]. ...
Background
Myxomas represent about 5–10% of primary cardiac tumors in children, and only about 2.5–4% of cardiac myxomas originate from ventricular chambers. Symptoms and signs of right ventricular tumors depend mainly on the size and the site of the tumor and its effect on the inflow and outflow of the blood.
Case presentation
A 15-year-old female patient presented with syncope on exertion and symptoms and signs of congestive heart failure. She had a history of dyspnea and palpitation on exertion for 2 years before admission. Echocardiography and cardiac magnetic resonance imaging (MRI) diagnose a huge right ventricular mobile mass (9 × 4.6 × 3.7 cm) prolapsing during systole into the main pulmonary artery and severe tricuspid regurgitation. The mass showed no contrast enhancement in early dynamic and delayed gadolinium images, suggestive of a thrombus. The mass was safely excised and tricuspid annuloplasty repair was done using right atriotomy and vertical right ventriculotomy approaches. The patient was discharged in a well condition on postoperative day 6. Pathologically, the mass was confirmed as cardiac myxoma with old extensive hemorrhage inside.
Conclusions
Early echocardiography is essential for patients complaining of unexplained cardiac symptoms for early diagnosis and management of rare cases. Multimodality imaging is needed for the diagnosis and planning of the surgical procedure of right ventricular masses. Hemorrhage inside myxoma may lead to no contrast enhancement of the tumor.
Primary cardiac tumors are extremely uncommon in young children and infants. Cardiac myxoma are typically found in the atria, predominately in the left atrium, with relatively few found on the right side, such as in the right ventricle or pulmonary artery. Numerous significant complications, including sudden death, can result from obstruction of the main pulmonary artery trunk and right ventricular outflow tract. Here, we describe the case of a 14-year-old Chinese girl diagnosed with a right ventricular myxoma located in the right ventricle and extended into the main pulmonary trunk. Complete resection of the myxoma and histological confirmation were performed.
Right ventricular outflow tract obstruction (RVOTO) is a cause of hemodynamic instability that can lead to right ventricular dysfunction. Cardiac tumors located in the right ventricle or surrounding structures can cause RVOTO. Herein, we present a rare case of a 21-year-old male with palpitations due to RVOTO caused by a cardiac multicomponent mesenchymal tumor. The tumor was localized in the right ventricular outflow tract, resulting in right side heart enlargement, tricuspid regurgitation, and RVOTO. Hence, tumor resection was performed. The patient was in a stable condition and discharged home on the 6th post-operative day. However, histopathological examination of the tumor specimen suggested a three-component mesenchymal tumor containing mucinous components, formed blood vessels, and fibrous tissue, which is like an atypical capillary hemangioma. After seven years of follow-up, the patient had no right heart enlargement, tricuspid regurgitation, and tumor recurrence. We believe surgical treatment is effective, and this case will provide a reference for clinicians to treat and evaluate the prognosis of similar three-component mesenchymal cardiac tumor cases in the future.
Background
Myxoma is the most common tumor of the heart that can cause embolism, obstruction, and cardiac failure, but rarely causes chylothorax. We herein report a case of chylothorax caused by left atrial myxoma, which responded to diuretic therapy and was subsequently cured by resecting cardiac myxoma.
Case presentation
This is a case of a 63-year-old male with symptoms of cardiac insufficiency who was diagnosed with a left atrial myxoma. The patient also had a massive pleural effusion on the right side, which was diagnosed as chylothorax by Sudan III staining and the content of triglyceride. The pleural effusion disappeared and the symptoms of heart failure were relieved after draining the effusion with a fine thoracic drainage tube, but pleural effusion and cardiac insufficiency symptoms relapsed soon. Although diuretic treatment can improve the symptoms and reduced the amount of chylous fluid preoperatively, the chylous pleural effusion was eventually cured by surgical removal of the tumor, and no recurrence of the tumor and chylothorax was found in the 6-month follow-up.
Conclusions
Chylothorax is rare comorbidity of cardiac myxoma. Large myxoma can cause congestive heart failure and lead to disfunction of chylous reflux, resulting in chylothorax, which can be cured by resection of the primary tumor.
