Excision of a cardiac paraganglioma

We present a case report detailing the surgical management of a cardiac paraganglioma in a 57-year-old man with a succinate dehydrogenase subunit B mutation and family history of paragangliomas. These neuroendocrine tumours arise from chromaffin cells and account for less than 3% of cardiac tumours. Succinate dehydrogenase subunit B mutations are associated with aggressive disease patterns and require a multidisciplinary approach for optimal management. The patient had multifocal disease involving the neck, abdomen and heart, yet was asymptomatic aside from a palpable neck mass. Positron emission tomography with fluorodeoxyglucose, echocardiography and coronary angiography identified a mass within the right atrial wall and concurrent significant narrowing of the left anterior descending coronary artery. The video tutorial demonstrates excision of the cardiac paraganglioma via median sternotomy, establishment of cardiopulmonary bypass, and right atrial exploration. No tumour was visualized within the chamber, and further inspection revealed a firm lesion in the right atrioventricular groove, infiltrating the myocardium and encasing the right coronary artery. The artery was transected and bypassed using a saphenous vein graft, allowing for complete tumour resection. A graft to the left anterior descending artery was also performed. Postoperative recovery was uncomplicated, and histopathology confirmed a cardiac paraganglioma with clear margins.