An enormous right atrial myxoma highlights the role of echocardiography in heart failure pathways: a case report.
Cardiac tumour
Case report
Myxoma
Tricuspid regurgitation
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
14
09
2021
revised:
27
10
2021
accepted:
25
01
2022
entrez:
2
3
2022
pubmed:
3
3
2022
medline:
3
3
2022
Statut:
epublish
Résumé
Myxomata are rare, benign, primary tumours of the heart which can present with a variety of symptoms depending on size, location, and mobility. Here, we report a case of enormous right atrial myxoma, obliterating the right atrial and right ventricular cavities presenting with symptoms of heart failure. A 66-year-old Caucasian female presented to primary care with symptoms of right heart failure and was found to have elevated N-terminal pro B-type natriuretic peptide of 2829 ng/L (normal value <125 ng/L). The patient was referred for urgent evaluation to the integrated heart failure service at our institution. Echocardiography revealed an enormous mobile mass attached to the right atrial septum, extending into the right ventricle and inferior vena cava measuring 90 × 42 mm. The patient underwent urgent surgical resection. Perioperative transoesophageal echocardiography demonstrated severe tricuspid regurgitation, which was treated with tricuspid annuloplasty ring. The patient made an uneventful recovery and was discharged. Subsequent imaging showed a reduction in right ventricular dimensions and improved systolic function. This case serves to remind us of the critical role of echocardiography in the diagnosis and management of people with breathlessness and raised natriuretic peptides. Therapies for heart failure are guided by ejection fraction, therefore timely and accurate diagnosis is critical. Moreover, as in this case, echocardiography can also identify other features of critical relevance to patient care.
Sections du résumé
BACKGROUND
BACKGROUND
Myxomata are rare, benign, primary tumours of the heart which can present with a variety of symptoms depending on size, location, and mobility. Here, we report a case of enormous right atrial myxoma, obliterating the right atrial and right ventricular cavities presenting with symptoms of heart failure.
CASE SUMMARY
METHODS
A 66-year-old Caucasian female presented to primary care with symptoms of right heart failure and was found to have elevated N-terminal pro B-type natriuretic peptide of 2829 ng/L (normal value <125 ng/L). The patient was referred for urgent evaluation to the integrated heart failure service at our institution. Echocardiography revealed an enormous mobile mass attached to the right atrial septum, extending into the right ventricle and inferior vena cava measuring 90 × 42 mm. The patient underwent urgent surgical resection. Perioperative transoesophageal echocardiography demonstrated severe tricuspid regurgitation, which was treated with tricuspid annuloplasty ring. The patient made an uneventful recovery and was discharged. Subsequent imaging showed a reduction in right ventricular dimensions and improved systolic function.
DISCUSSION
CONCLUSIONS
This case serves to remind us of the critical role of echocardiography in the diagnosis and management of people with breathlessness and raised natriuretic peptides. Therapies for heart failure are guided by ejection fraction, therefore timely and accurate diagnosis is critical. Moreover, as in this case, echocardiography can also identify other features of critical relevance to patient care.
Identifiants
pubmed: 35233493
doi: 10.1093/ehjcr/ytac042
pii: ytac042
pmc: PMC8874817
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytac042Subventions
Organisme : British Heart Foundation
ID : FS/CRTF/20/24071
Pays : United Kingdom
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Am Heart J. 2000 Jul;140(1):134-8
pubmed: 10874274
Anatol J Cardiol. 2017 Mar;17(3):241-247
pubmed: 28321109
Int J Health Sci (Qassim). 2018 Jan-Feb;12(1):59-63
pubmed: 29623019
Circulation. 2008 Sep 30;118(14 Suppl):S7-15
pubmed: 18824772
Am J Case Rep. 2012;13:29-32
pubmed: 23569480
Front Oncol. 2018 Nov 21;8:540
pubmed: 30524967
Eur Heart J. 2021 Sep 21;42(36):3599-3726
pubmed: 34447992
Circ Cardiovasc Imaging. 2019 Mar;12(3):e008820
pubmed: 30813772
Heart. 2016 Aug 1;102(15):1230-45
pubmed: 27277840
Medicine (Baltimore). 2018 Sep;97(37):e12397
pubmed: 30213011