Abstract
Primary heart neoplasms are rare occurring with an estimated incidence of 0.0017-0.19%. Myxoma is the most prevalent primary heart tumor. The right atrium is an unusual localization, occurring only in 15-20% of myxoma cases. We report a rare case of a massive right atrial myxoma causing tricuspid valve obstruction and presenting as syncope and exertional dyspnea. This case illustrates the influence of myxoma's size, position and mobility as well as patient's body posture and respiration to the development of signs and symptoms. Three-dimensional echocardiography proved useful in surgery planning, allowing a better definition of the tumor outline and attachment.
Highlights
Primary tumors of the heart are rare, with an estimated incidence ranging 0.0017-0.19%, accounting for < 5% of all cardiac tumors
Transthoracic 3 D echo allowed a better definition of the mass outline and confirmed the attachment to the interatrial septum below the fossa ovalis (Figure 3, Additional file 3)
Transthoracic echocardiogram (TTE) provided a good visualization of the mass, 3 D echo proved helpful in surgery planning, allowing a better definition of the tumor outline, position and attachment in the interatrial septum
Summary
Primary tumors of the heart are rare, with an estimated incidence ranging 0.0017-0.19%, accounting for < 5% of all cardiac tumors. Right atrial myxomas are rare as myxomas are estimated to occur in the right atrium in only 15-20% of the cases [1]. The low incidence rate of right atrial myxoma has been reported for decades in several autopsy case series. Yu et al, in a surgical case series, reviewed 33108 patients submitted to cardiac surgery and found 234 cases with a confirmed diagnosis of primary heart tumor (0.71%). We present a rare clinical case of a massive right atrial myxoma with an uncommon clinical presentation. Doppler revealed a mean pressure gradient between right atrium and ventricle of 4 mmHg. Transthoracic 3 D echo allowed a better definition of the mass outline and confirmed the attachment to the interatrial septum below the fossa ovalis (Figure 3, Additional file 3). In the follow-up performed two months after surgery, the patient reported a significant symptomatic improvement
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