CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
AFRICA
e13
Giant right atrial myxoma leading to cardiac arrest in an
infant
C VURAN, K BABAOGLU, E OZKER, C AYABAKAN, B SARITAS, OI KOCYIGIT, R TURKOZ
Abstract
We present the case of a three-month-old infant with a giant
right atrial myxoma obstructing the tricuspid valve, who
following haemodynamic deterioration and cardiac arrest,
was operated upon as an emergency. On echocardiogram,
there was a mass attached to the tricuspid annulus, in close
proximity to the septal leaflet, with dimensions of 16.6
×
12.5
mm. The mass was prolapsing through the tricuspid valve
into the right ventricle and obstructing the inflow. While
preparing for surgery, cardiac arrest occurred, so the patient
underwent an emergency operation under cardiopulmonary
resuscitation. The mass was excised without damaging the
tricuspid valve and the conduction system. Histologically, the
mass consisted of a myxoid matrix with scatted globoid and
star-shaped myxoma cells. The patient stayed 15 days in the
intensive care unit and was discharged home on the 20th day
postoperatively.
Although accepted as a benign tumour, a myxoma can
display an aggressive clinical course in infants. In centres
where cardiac operations cannot be performed, these
patients need to be transferred to cardiac centres as soon
as possible. Whatever the clinical presentation, we advocate
immediate surgical extirpation of the tumour in order to
avoid any unpredictable consequences in its clinical course.
Keywords:
atrial myxoma, giant heart tumour, paediatric cardiac
surgery, infant, urgent operation
Submitted 27/9/10, accepted 26/11/10
Cardiovasc J Afr
2012;
23
: e13–15
DOI: 10.5830/CVJA-2010-099
The prevalence of heart tumours in children is difficult to esti-
mate since data are available only from leading paediatric centres
and these data are restricted to autopsy and case records. They
constitute less than 0.1% of all neoplasms and occur with an
incidence of 0.0017 to 0.28% in autopsy records.
Approximately 90% of heart tumours in children are benign,
however clinical presentations and their consequences depend
on their location. Although in adults, myxomas are the most
common benign cardiac tumours, in the paediatric population,
the most prevalent is the rhabdomyoma, which accounts for
50% of all primary cardiac tumours in children.
1
Myxoma is the
third most common neoplasm in children after rhabdomyoma
and fibroma, accounting for 10 to 15% of all cardiac tumours
in children.
These tumours show many presenting symptoms which
include haemodynamic obstruction, systemic manifestations
and embolic phenomena, the latter being rare in the first months
of life.
2
Despite the benign pathological pattern of myxomas,
their growth in a small child’s heart can make it clinically very
aggressive, requiring emergency treatment. Here we present a
three-month-old infant with a giant right atrial myxoma obstruct-
ing the tricuspid valve, who was deteriorating haemodynamically
and operated on as an emergency.
Case report
A haemodynamically unstable three-month-old girl was trans-
ferred from another centre to our clinic for urgent cardiac
surgery. The patient was admitted to the initial clinic with dys-
pnoea. She was cyanotic and the parents complained of difficulty
Department of Cardiovascular Surgery, Baskent University,
Istanbul Hospital, Istanbul, Turkey
C VURAN, MD,
E OZKER, MD
B SARITAS, MD
R TURKOZ, MD
Department of Paediatric Cardiology, Kocaeli University,
Istanbul, Turkey
K BABAOGLU, MD
Department of Paediatric Cardiology, Baskent University,
Istanbul Hospital, Istanbul, Turkey
C AYABAKAN, MD
Department of Anesthesiology, Baskent University, Istanbul
Hospital, Istanbul, Turkey
OI KOCYIGIT, MD
Fig. 1. Pre-operative echocardiographic image of right
atrial myxoma.
Case Report
