Intraoperative embolism of a right atrial myxoma: a case report

Atrial myxomas are the most common benign cardiac tumours. Clinical manifestations vary from constitutional symptoms, to valvular stenosis and embolic events, and surgical removal is the only suggested treatment.

A 50-year-old female patient was referred to our centre for surgical excision of a reported right atrial mass. A transoesophageal echocardiographic exam revealed two right atrial masses and the surgical plan was total removal of both masses. However, during the operation the surgeons were not able to locate the larger of the two masses and embolization to the pulmonary trunk was considered as the most likely explanation in this setting. A control suction of the right ventricle and the proximal part of the pulmonary arteries was performed to check if the mass had embolized distally but this did not yield any mass. The patient was transferred to the intensive care unit and remained stable for 2 h, until she developed an abrupt cardiogenic shock with signs of right heart failure. An emergent pulmonary computed tomography angiography demonstrated the embolized mass to the left pulmonary artery and the patient was retransferred to the operating room for emergent surgical removal of the mass. The patient showed immediate clinical and haemodynamic improvement after the removal of this mass and had an uneventful further hospitalization.

Multiple right atrial myxomas are rarely reported and surgical excision requires experience, as in case of embolization immediate removal must be obtained to prevent from right ventricle distress and cardiogenic shock.