Abstract
Right ventricular (RV) myxomas are extremely rare, but may have dreadful clinical sequelae including pulmonary embolism (PE). We present a case of a patient who had an RV myxoma that was attached to the tricuspid valve, and therefore could not be resected completely during surgery, and remnants of the tumor were seen on transthoracic echocardiogram during post-operative follow-up. Five months after surgery, the patient had PE, which could be due to tumor emboli or thromboemboli. Since repeat surgical resection was not feasible, the patient was started on warfarin. The patient is doing well and has had no PE recurrence over the past 20 months of follow-up. We have complemented the current case report with a comprehensive literature search and review on RV myxomas associated with PE in order to shed light on this uncommon but potentially lethal disorder. We concluded that right-sided cardiac myxomas, including RV myxomas, should be considered while dealing with PE, particularly in young patients with no risk factors, and that follow-up with echocardiography after surgery is important due to the possibility of recurrence, especially if complete resection was difficult to perform.Plain Language SummaryPlain language summary available for this article.
Highlights
Primary cardiac tumors are infrequent [1]
We present a review of the literature pertaining to Right ventricular (RV) myxomas associated with pulmonary embolism (PE) in an effort to provide an insightful understanding of such cases
Postoperative Transthoracic echocardiogram (TTE) in our case revealed dilation of the inferior vena cava (IVC), right atrium and right ventricle, which we believe could be due to the mild TR revealed on the transesophageal echocardiogram (TEE) done during the surgery after excising the mass
Summary
Primary cardiac tumors are infrequent [1]. Myxoma is the most common type of such tumor in adults [2]. Transthoracic echocardiogram (TTE) revealed an RV mass (approximately 3 9 2 cm) attached to the interventricular septum by a small pedicle, dilated right heart chambers, moderate tricuspid regurgitation, and severe pulmonary hypertension (systolic pulmonary artery pressure [ 60 mmHg) (Fig. 1). The patient took 15 airplane flights over the previous 2 months, some of which were very long He was tachypneic (22 breaths/ min), and his ECG showed sinus tachycardia with a heart rate of 118 bpm and right bundle branch block (RBBB). TTE and transesophageal echocardiogram (TEE) were done and reported dilation of the inferior vena cava (IVC), right atrium and right ventricle and a mass (approximately 2 9 1.5 cm) attached to the base of the RV wall just below the insertion of the anterior tricuspid leaflet (Fig. 5). Informed consent was obtained from the patient for being included in the study
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