Tricuspid valve obstruction and right heart failure due to a giant right atrial myxoma arising from the superior vena ca
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CASE REPORT
Open Access
Tricuspid valve obstruction and right heart failure due to a giant right atrial myxoma arising from the superior vena cava Zheng-hua Xiao†, Jia Hu†, Da Zhu, Ying-kang Shi and Er-yong Zhang*
Abstract Myxomas are the most common primary cardiac tumors. The cardiac myxomas are mostly diagnosed within the atria, and only a few such tumors are reported to have arisen from atrioventricular valves or pulmonary vessels. The authors here present a case of 59-year-old Chinese woman who was hospitalized for exacerbating symptoms of tricuspid stenosis and right heart failure. Echocardiography revealed a giant right atrial myxoma arising from an extremely rare site, the anterior wall of the superior vena cava. With the aid of transesophageal echocardiography, the surgical resection was performed successfully with the patient achieving complete recovery. Keywords: Myxoma, Superior vena cava, Echocardiography
Background Primary cardiac tumor represents a rare subgroup of malignancies in humans with an incidence between 0.0017 and 0.29 percent in autopsy series performed in nonselected populations [1,2]. The most prevalent type of the intra-cardiac tumor is myxoma, which is approximately 0.5-1 cases per 106 individuals per year, with apparent preponderance (3:1) of female patients [3,4]. Although the majority of cardiac myxomas (CMs) are histologically benign, due to their strategic location (left or right cardiac chamber) and nature (size, mobility and overall morphology), they may lead to serious consequences for morbidity and mortality of affected patients. The occurrence of CMs is mainly sporadic (90%) and is commonly observed within the left atrium (60-80%) [1,2,5]. As reported by previous studies, about 15-28% of CMs are diagnosed in the right atrium, 8% in the right and 3-4% in the left ventricle, and a small proportion of CMs are biatrial [1,2,6,7]. There are also less common reports of CMs involving all cardiac chambers and originating from mitral leaflets, aortic valves and pulmonary vessels [7-11]. Here we present an extremely rare case of a
* Correspondence: [email protected] † Equal contributors Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
giant superior vena cava (SVC)-originated myxoma mimicking tricuspid valve obstruction and right heart failure.
Case presentation A 59-year-old Chinese woman with a 10-year history of exertional dyspnea and palpitations was hospitalized for exacerbating symptoms of right heart failure from one month prior to admission. On physical examination, her pulse rate was 99 beats per minute, and blood pressure was 111/80 mmHg. She had moderate bilateral pitting leg edema, a distended jugular vein and mild dilatation of superficial neck and facial veins. An accentuated second heart sound without tumor plop was heard on auscultation. Electrocardiogram showed sinus rhythm with right bundle branch block. Chest X-ray and abdominal computed tomography were unremarkable. The results of lower extremity u
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