Massive right atrial myxoma causing exertional dyspnoea

Metastatic tumours are the commonest cardiac tumours being found in 1-3% of patients dying of cancer while primary tumours are unusual and have an incidence of 0.02-0.5%. The majority (80%) of all primary cardiac tumours are benign with myxomas accounting for 50%. Myxomas arising from the right atrium are uncommon. We present the case of a 39-year-old female with a 4-month history of progressive exertional dyspnoea accompanied by symptoms of palpitations and presyncope. Transthoracic echocardiography showed an extremely large right atrial myxoma prolapsing into the right ventricle and obstructing the tricuspid valve. We demonstrate how intraoperative transoesophageal echocardiography, prior to sternotomy, was useful in providing information about the myxoma which clearly displayed its attachment and anatomical relationship in the planning of the 'safe' surgical excision.