A case of multifocal right atrial myxoma extending into the superior venacava with patent foramen ovale presenting with systemic thromboembolic stroke: A case report

Abstract

Myxomas are considered the most common among primary tumors. But right atrial myxomas are relatively rare.[1] A 49 year old male presented with left upper and lower limb hemiparesis which recovered spontaneously without residual weakness within 24 h without thrombolysis. A known diabetic and hypertensive, he was thoroughly evaluated which revealed a multifocal right atrial myxoma attached to the right atrial free wall and extending into the superior venacava. Serum anti-cardiolipin antibody IgG was positive. The myxoma was promptly excised under general anaesthesia. Cardiopulmonary bypass was instituted with cannulation of the aorta, right femoral vein draining the inferior venacava (IVC) and high superior venacava (SVC) under transesophageal echocardiography guidance. The sieve like infiltrations into the SVC were excised by briefly decannulating the SVC followed by immediate recannulation. Myocardial protection was ensured with pulmonary artery venting, del Nido cardioplegia, sterile topical ice saline and terminal warm reperfusion. The patent foramen ovale was directly closed with prolene sutures. Right atrial myxomas are known to be associated with antiphospholipid antibody syndrome, thus making it mandatory to be ruled out.[2] Right atrial myxomas are rare and those associated with patent foramen ovale are a further rarity.[4] Our approach to the excision of the myxoma has been unique since the inferior venacava was drained with right femoral vein cannulation to prevent disrupting the mass and further embolism, pulmonary artery venting was done instead of left atrial venting to prevent manipulation of the mass during right atrial retraction and the resection of the mass infiltrating into the SVC wall was done carefully by briefly decannulating the SVC and immediately recannulating post resection.