Tumor embolism from a right atrial myxoma leads to acute right heart failure after surgery and atrial septal patch dehiscence

摘要

A 54-year-old woman with multiple right atrial myxoma (A to D, Online Videos 1,2, 3, and 4) from the fossa ovalis of the atrial septum underwent complete excision of the tumor mass (E to G) along with the atrial septum, and the resultant surgically-created atrial septal defect was patch closed with pericardium. After surgery, she had moderate pulmonary hypertension and tricuspid regurgitation (H, Online Video 5) and a complete lack of perfusion of the right lower lobe (I). Her condition worsened 2 weeks later, with severe cyanosis caused by atrial septal patch dehiscence (J and K). Cardiac catheterization showed elevated atrial and right ventricular end-diastolic pressures and a right-to-left shunt across the atrial septal defect. A large tumor embolus with calcified speckles (arrows) identified in the right lower-lobe pulmonary artery (L, Online Video 6) was snared to the inferior vena cava (M, Online Videos 7 and 8). After device closure of the residual atrial septal defect, oxygen saturations improved to normal levels and the right lower lobe was well perfused (N, Online Video 9). An inferior vena cava filter trapped the tumor below the renal veins (O, Online Video 10). An inferior vena cava filter trapped the tumor below the renal veins. Ao = aorta; LA = left atrium; Lt = left; LV = left ventricle; Obli = oblique; RA = right atrium; Rt = right; RV = right ventricle.