TVD with RA mass associated with severe LV dysfunction treated successfully

in Max Super Speciality Hospital, Shalimar Bagh

Jan 16 , 2023

A 62-year-old patient was brought to the emergency of Max Super Speciality Hospital, Shalimar Bagh, with oxygen and high inotropic support. He complained of chest pain and dyspnoea on exertion for 5-6 months. He had history of ventricular arrhythmia post CPR at other hospital. He also had comorbidities of Diabetes and hypertension.

On physical examination, the patient looked little restless, dyspnoeic, but well-oriented. On auscultation, Tumor plop sound was heard at left third para-sternal region. Chest X-ray showed prominent markings and haziness in upper zone in both the lung fields. 2D ECHO 2D ECHO revealed hyperechoic, non-calcific mobile mass of uniform echogenicity of size 3.7 x 3.8 cm present in RA and possibly attached to lateral wall of right atrium, Low-Mod MR. Hypo kinetic LAD territory, EF-22%, CAG s/o Triple Vessel disease.

Just before shifting to OT, patient had VT, shocked, reverted and taken into OT. Under general anaesthesia median sternotomy performed, Cardio Pulmonary Bypass (CPB) instituted. The mass appeared to occupy entire RA with stalk attached to lateral wall of RA near RA-IVC junction mass was excised. LAD/OM/PDA grafted, CPB weaned with moderate inotrops. Mass was sent for histopathological examination. The patient was shifted to CTVS ICU in clinically stable condition.

Post-operatively, the patient was gradually weaned off from the ventilator and extubated next morning. Post-operative course was smooth with few arrhythmias. Patient was discharged in clinically stable condition. On follow-up, patient had good cardiac function and activity. Biopsy confirmed myxoma.