Abstract
Right ventricular (RV) myxoma that obstructs the RV outflow tract is rare. Multimodality imaging is crucial due to the curved and triangular shape of the RV anatomy. Incomplete resection by the right atrial approach in cardiac myxomas may be prevented by preoperative imaging with echocardiography, computed tomography and magnetic resonance imaging to provide detailed visualization. Right ventriculotomy may be an alternative approach to the isolated atrial approach to get complete resection of RV myxoma in suitable patients. The preferred surgical treatment is not well defined for ventricular myxomas and careful preoperative planning is essential. Surgical resection should be performed as soon as possible to avoid outflow tract obstruction, which might result in sudden death. The collaboration between cardiologist and heart surgeon and the effective use of imaging tools are essential for successful treatment. In this article, diagnosis and treatment and the heart team approach to RV myxoma are discussed with a demonstrative patient.
Highlights
Cardiac myxomas are benign tumors of endocardial origin
We present a patient with recurrent right ventricle (RV) myxoma evaluated by multimodality imaging and successfully managed
There is no clear explanation for a surgical approach in RV myxomas, right atrial surgical approach and the absence of detailed examination of the tumor’s invasion site with multimodality imaging and the curved shape of the right ventricle may cause incomplete resection in our case[3,4,5]
Summary
Cardiac myxomas are benign tumors of endocardial origin. Symptoms might mimic heart disease as well as infectious disease, immunodeficiency, and malignant processes. We detected a large RV myxoma connected to the basal free wall and anterior leaflet of the tricuspid valve with 2-D TTE, CMR and computed tomography (CT) (Figure 1A and 1B, Video 1 to 3). Video 1 - Two-dimensional transthoracic echocardiography, parasternal short axis view, shows right ventricular mass connected to the right ventricular basal free wall. Video 5 - Postoperative two-dimensional transthoracic echocardiography short axis view shows the absence of a right ventricular mass. Video 3 - Two-dimensional transthoracic echocardiography shows right ventricular mass attached to the anterior leaflet of the tricuspid valve. Video 7 - Postoperative color Doppler two-dimensional transthoracic echocardiography four-chamber view shows mild tricuspid regurgitation and absence of right ventricular outflow tract obstruction. Video 4 - Two-dimensional transthoracic echocardiography color Doppler shows the systolic motion of the right ventricular mass and systolic turbulence, which means right ventricular outflow tract obstruction
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