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CASE20191115_010
| STRUCTURAL HEART DISEASE - Others (STRUCTURAL HEART DISEASE) | |
| A Rare Case of Right Atrium Cardiac Myxoma with Pulmonary Embolisms in Right and Left Pulmonary Artery | |
| Nazla Amanda1, Ni Nyoman Novia Candra Dwipa1, Okki Masitah Syahfitri Nasution1, Djoen Herdianto1, Ivan Joalsen1, Eko Nugroho Raharjo1 | |
| Abdul Wahab Sjahranie General Hospital, Indonesia1, | |
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[Clinical Information]
- Patient initials or identifier number:
NF
-Relevant clinical history and physical exam:
A woman in her early 30s was admitted to hospital with a complaint of dyspnea and cough, especially on exertion. Patient also reported a history of syncope 1 month before the visit to hospital. No history of the same complaint in the past. No history of chest pain. Vital signs were all in normal range. Physical examinations were all normal, with no edema noted in any site of the body.
 -Relevant test results prior to catheterization:
ECG revealed sinus rhythm, chest x-ray showed clear lung fields with the enlargement of right atrium, transthoracic echocardiography revealed a moving large mass in the right atrium with stalk, attached to the right atrium with no tricuspid regurgitation noted. Cardiac CT-Scan revealed solid hypodense mass in RA, and embolisms in both right pulmonary artery and left pulmonary artery.
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
Patient was referred to cardiothoracic surgeon and surgery was planned. Patient was given Xarelto 20 mg (Bayer, Indonesia) once a day, an anticoagulant, to prevent further embolism while preparing patient for surgery. Medication was stopped 3 days prior to surgery. In patient, cardiothoracic surgeon did excision of the RA mass and evacuation of the pulmonary embolisms followed by RPA and LPA reconstruction. Evacuated mass was evaluated by pathologists and showed microscopic results of myxoid cells, characteristic of myxoma. Patient was monitored in ICCU for 1 day before being moved to general wards for a total length of stay for 5 days before being discharged. Patient was given aspirin (100 mg once a day), clopidogrel (75 mg once a day) and acetaminophen (500 mg thrice a day) as maintenance therapy post-procedure. Post-operative CT showed no residual mass in RA and a small part of embolism in RPA and LPA. Patient was followed up one-week later in out-patient clinic and revealed cessation of dyspnea and cough. Follow-up echocardiography was done and revealed no residual mass in RA.
   - Case Summary:
Cardiac myxoma is one of the most common cardiac tumors with predilection in the left atrium. In this case, we reported a patient with myxoma in rare location, which is the right atrium and also the collaboration between cardiologist and cardiothoracic surgeon in the management of the patient.
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