CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
e14
AFRICA
in breastfeeding.
In the physical examination, a mid-diastolic murmur was
present, best heard at the left third intercostal space. On echocar-
diogram, the right ventricle was dilated and there was a mass
of 16.6
×
12.5 mm attached to the tricuspid annulus in close
proximity to the septal leaflet (Fig. 1). The mass was prolapsing
into the right ventricle through the tricuspid valve and obstruct-
ing the inflow. The peak and mean diastolic gradients across the
valve were 13.5 and 7.1 mmHg, respectively. There was also a
right-to-left shunt through the patent foramen ovale, which had
a diameter of 1.7 mm.
When the patient was admitted to our hospital, she had
already been intubated and was haemodynamically unstable.
On dopamine and adrenaline treatment, her blood pressure was
60/30 mmHg and the heart rate was 70 beats/minute. In her
arterial blood gas there was profound metabolic acidosis. The
patient was taken to the operating room for an urgent opera-
tion. While preparing for surgery, cardiac arrest occurred, so the
patient underwent emergency operation under cardiopulmonary
resuscitation.
Following a median sternotomy, cardiopulmonary bypass
was achieved through aortic and two-stage right atrial cannula-
tion. Cardiac arrest was maintained through cross clamping
of the aorta and normothermic blood cardioplegia. In order to
convert to total cardiopulmonary bypass, bicaval cannulation
was performed. The right atrium was opened.
The mass of 2.0
×
1.5
×
2.0 cm was identified on the
interatrial septum, attached by a stalk to the septal leaflet at the
edge of the tricuspid valve. The mass was protruding into the
right ventricle via the tricuspid leaflet, which was sub-totally
obstructed by the mass (Fig. 2). The mass was excised with a
limited perimeter in order to avoid any damage to the tricuspid
valve and the conduction system. The right atriotomy was closed
and cardiopulmonary bypass was terminated.
Macroscopic examination revealed a mass with a smooth but
irregular surface, grey-yellow in colour (Fig. 3). Histologically,
the mass consisted of a myxoid matrix with scatted globoid and
star-shaped myxoma cells. The diagnosis of right atrial myxoma
was confirmed.
The postoperative course was eventful. The patient had acute
renal insufficiency due to the prolonged pre-operative low cardi-
ac output. On the first postoperative day, the blood creatinine and
BUN levels rose to 2.83 and 51 mg/dl, respectively. Since there
was no urine output, peritoneal dialysis was initiated and contin-
ued until the 10th postoperative day, when the spontaneous urine
output was sufficient. On the first postoperative day, the patient
also had generalised convulsions and was put on phenobarbital
treatment. She was weaned from ventilator support on the 11th
postoperative day.
Fig. 2. Intra-operative image of right atrial myxoma.
Fig. 3. Macroscopic view of right atrial myxoma.
