A Rare Case of Right Ventricular Myxoma Causing Recurrent Stroke

Overview

Journal Indian Heart J

Publisher Elsevier

Specialty Cardiology & Vascular Diseases

Date 2016 Oct 19

PMID 27751344

Citations 5

Authors

Prakash Aroor Sarvotham Rao

S N Nagendra Prakash

Somanath Vasudev

M Girish

Arun Srinivas

H P Guru Prasad

P Jayakumar

Venu Gopal Anandaswamy

Affiliations

Soon will be listed here.

Abstract

We present a 62-year-old lady admitted in our hospital with two episodes of acute ischemic stroke about 2 weeks apart. She was evaluated for acute ischemic stroke and was thrombolysed for recent stroke in right MCA territory first time. On further evaluation, she was found to have a RVOT mass. A transthoracic and transesophageal echocardiogram revealed a PFO and a large, 5.1cm×2.3cm, ovoid, well circumscribed, echogenic mass in the right ventricle outflow tract attached by small pedicle to the ventricular side of anterior tricuspid leaflet, partly obstructing the right ventricular outflow tract and protruding through the pulmonic valve during systole. She was scheduled for surgery (right ventricular mass excision and PFO closure) after 3 weeks due to the risk of secondary hemorrhage in the infarcted area following thrombolysis and anticoagulation and so was discharged with medications after full neurologic recovery after about a week of hospital stay. She was readmitted 7 days after discharge, before the scheduled date of surgery with history of weakness of right upper limb, slurred speech and mild breathing difficulty lasting for about 20min following which she improved slowly (transient ischemic attack). The tumor was completely removed with the stalk using cardiopulmonary bypass support. The histopathological findings confirmed the diagnosis of myxoma.

Citing Articles

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Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis.

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Unusual aspects of cardiac myxoma.

Yuan S, Yan S, Wu N Anatol J Cardiol. 2017; 17(3):241-247.

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References

OBEID A, Marvasti M, Parker F, Rosenberg J . Comparison of transthoracic and transesophageal echocardiography in diagnosis of left atrial myxoma. Am J Cardiol. 1989; 63(13):1006-8. DOI: 10.1016/0002-9149(89)90162-8. View

Farah M . Familial cardiac myxoma. A study of relatives of patients with myxoma. Chest. 1994; 105(1):65-8. DOI: 10.1378/chest.105.1.65. View

Mukadam M, Kulkarni H, Kumar C, Tendolkar A . Right-ventricular myxoma presenting as right-ventricular outflow-tract obstruction--case report and review of the literature. Thorac Cardiovasc Surg. 1994; 42(4):243-6. DOI: 10.1055/s-2007-1016497. View

McCarthy P, Piehler J, Schaff H, Pluth J, Orszulak T, Vidaillet Jr H . The significance of multiple, recurrent, and "complex" cardiac myxomas. J Thorac Cardiovasc Surg. 1986; 91(3):389-96. View

Centofanti P, Di Rosa E, Deorsola L, Dato G, Patane F, La Torre M . Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Ann Thorac Surg. 1999; 68(4):1236-41. DOI: 10.1016/s0003-4975(99)00700-6. View

Dein J, Frist W, Stinson E, Miller D, Baldwin J, Oyer P . Primary cardiac neoplasms. Early and late results of surgical treatment in 42 patients. J Thorac Cardiovasc Surg. 1987; 93(4):502-11. View

Hanson E, Gill C, Razavi M, Loop F . The surgical treatment of atrial myxomas. Clinical experience and late results in 33 patients. J Thorac Cardiovasc Surg. 1985; 89(2):298-303. View

Chitwood Jr W . Cardiac neoplasms: current diagnosis, pathology, and therapy. J Card Surg. 1988; 3(2):119-54. DOI: 10.1111/j.1540-8191.1988.tb00232.x. View

Karagounis A, Sarsam M . Myxoma of the free wall of the right ventricle: a case report. J Card Surg. 2005; 20(1):73-6. DOI: 10.1111/j.0886-0440.2005.05006.x. View

10.

Meier B, Lock J . Contemporary management of patent foramen ovale. Circulation. 2003; 107(1):5-9. DOI: 10.1161/01.cir.0000046073.34261.c1. View

11.

Larrieu A, Jamieson W, Tyers G, Burr L, MUNRO A, Miyagishima R . Primary cardiac tumors: experience with 25 cases. J Thorac Cardiovasc Surg. 1982; 83(3):339-48. View

12.

Sievert H, Horvath K, Zadan E, Krumsdorf U, Fach A, Merle H . Patent foramen ovale closure in patients with transient ischemia attack/stroke. J Interv Cardiol. 2002; 14(2):261-6. DOI: 10.1111/j.1540-8183.2001.tb00745.x. View

13.

Bateman T, Gray R, Raymond M, Chaux A, Czer L, Matloff J . Arrhythmias and conduction disturbances following cardiac operation for the removal of left atrial myxomas. J Thorac Cardiovasc Surg. 1983; 86(4):601-7. View

14.

BENNETT K, Gu J, Adair T, Heath B . Elevated plasma concentration of vascular endothelial growth factor in cardiac myxoma. J Thorac Cardiovasc Surg. 2001; 122(1):193-4. DOI: 10.1067/mtc.2001.113744. View

15.

GOLDSTEIN M, Casey M, Carney J, Basson C . Molecular genetic diagnosis of the familial myxoma syndrome (Carney complex). Am J Med Genet. 1999; 86(1):62-5. DOI: 10.1002/(sici)1096-8628(19990903)86:1<62::aid-ajmg12>3.0.co;2-1. View

16.

Chitwood Jr W . Clarence Crafoord and the first successful resection of a cardiac myxoma. Ann Thorac Surg. 1992; 54(5):997-8. DOI: 10.1016/0003-4975(92)90676-u. View

17.

Castaneda A, VARCO R . Tumors of the heart: surgical considerations. Am J Cardiol. 1968; 21(3):357-62. DOI: 10.1016/0002-9149(68)90139-2. View

18.

Mendoza C, Rosado M, Bernal L . The role of interleukin-6 in cases of cardiac myxoma. Clinical features, immunologic abnormalities, and a possible role in recurrence. Tex Heart Inst J. 2001; 28(1):3-7. PMC: 101121. View

19.

Bjessmo S, Ivert T . Cardiac myxoma: 40 years' experience in 63 patients. Ann Thorac Surg. 1997; 63(3):697-700. DOI: 10.1016/s0003-4975(96)01368-9. View

20.

Gonzalez A, Altieri P, Marquez E, Cox R, Castillo M . Massive pulmonary embolism associated with a right ventricular myxoma. Am J Med. 1980; 69(5):795-8. DOI: 10.1016/0002-9343(80)90455-6. View