Cardiothoracic Surgery: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery |

Recurrent Myxoma With Thrombosis FREE TO VIEW

Ali Ghani, MD; Rubin azad, MD; Wajahat Humayun, MD; Ahsan Raza, MD
Author and Funding Information

Abington Jefferson Health, Horsham, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):53A. doi:10.1016/j.chest.2016.08.060
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Metastatic malignancy to heart is 20-40 times more common that primary heart malignancy. Recurrence of right ventricular myxoma is extremely rare. Its incidence is about 3% of patients with sporadic. We report here a unique case of recurrent right ventricular myxoma in addition to a blood clot in right ventricle.

CASE PRESENTATION: A 30 year old female with no significant past medical history was seen in an outpatient cardiology clinic for dyspnea on exertion. Initial Vitals: BP 140/80, Pulse 84, RR 18, afebrile. Physical examination revealed regular s1/s2 with new III/VI pansystolic murmur with clear lungs. An echocardiogram (ECHO) showed large mass in right ventricle near right ventricular outflow tract. Emergent CT surgery was done with excision was performed for myxoma. Patient also underwent tricuspid valve replacement (TVR) with pericardial closure. A repeat ECHO two days later showed a clot in right ventricle. Patient was started on intravenous heparin later switched to warfarin and was discharged to follow up as outpatient. A follow up ECHO showed recurrence of mass in right ventricle for which cardiac magnetic resonance imaging (cMRI) was done. It showed that the mass was a combination of recurrent myxoma and clot and was very extensive involving a major portion of the right ventricular free wall. Patient was referred to a transplant center for possible heart transplantation. After extensive discussions, it was decided to attempt redo surgery for resection of the recurrent mass. The pathology of the mass showed myxoma again. All the outpatient workup was negative for a clotting disorder.

DISCUSSION: Several different mechanisms for recurrence include; regrowth, inadequate resection or multicentric disease. Patients with myxomas are at increased risk of emboli, outflow tract obstruction. Recurrence of right ventricular myxoma can be very challenging and should be closely followed with serial imaging studies like TEE. Our case is first reported one in terms of combined myxoma and thrombosis with recurrence.

CONCLUSIONS: We recommend serial monitoring of patients with myxoma with repeat imaging for early detection in case of recurrence to avoid any complications. A low index of suspicion for doing a TEE rather than TTE can be very useful in case of recurrence of symptoms and close follow up can be very useful in early detection and management of recurrence of intracardiac myxoma. Operative repair along with valve replacement is standard of treatment.

Reference #1: The Right Ventricular Myxoma Which Attached to the Tricuspid Valve: Sliding Tricuspid Valvuloplasty Seong Ho Cho, M.D.,1 Man-Shik Shim, M.D.,2 and Wook Sung Kim, M.D.2

Reference #2: Ioannis A Paraskevaidis, Konstantinos Triantafilou, Dimitrios Karatzas, Dimitrios Th. Kremastinos. (2003) Right ventricular multiple myxomas obstructing right ventricular outflow tract. The Journal of Thoracic and Cardiovascular Surgery126, 913-914

DISCLOSURE: The following authors have nothing to disclose: Ali Ghani, Rubin azad, Wajahat Humayun, Ahsan Raza

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543