Correspondence

Right Ventricular Myxoma

N Engl J Med 2000; 342:295January 27, 2000

Article

To the Editor:

Metastatic tumors that invade the heart occur 20 to 40 times more frequently than primary tumors. Of the primary cardiac tumors, 75 percent are benign, and of these benign tumors, myxomas are the most common. The remaining primary cardiac tumors are malignant, the overwhelming majority of which are sarcomas. Cardiac sarcomas arise from the right side of the heart in 25 percent of reported cases, whereas myxomas arise from right-sided cardiac structures in only 5 percent of cases.1-4 Thus, an intracavitary tumor that obstructs the right ventricular outflow tract is about 300 times more likely to be malignant than benign. We report the case of a patient with an unusual myxoma that arose from the interventricular septum of the right ventricular outflow tract.

A 74-year-old retired welder with a long history of smoking was hospitalized because of worsening exertional dyspnea, frequent dizzy spells, and one episode of fainting. Transesophageal echocardiography showed a mass in a dilated right ventricle (Figure 1AFigure 1Transesophageal Echocardiograms of a Right Ventricular Myxoma.). The mass, which obstructed the right ventricular outflow tract, was attached to the interventricular septum by a small pedicle (Figure 1B) and protruded through the pulmonic valve during systole.

At cardiac catheterization, the central venous pressure was 21 mm Hg, and the right ventricular systolic and diastolic pressures were 76 and 8 mm Hg, respectively. The coronary arteries were normal. At surgery, the origin of the mass was identified 1 cm below the pulmonic valve and was attached to the right ventricular outflow tract on its septal surface. It was removed through the pulmonary artery. The histopathological findings were characteristic of myxoma. The patient recovered uneventfully.

In this case, the patient's symptoms were due to an obstruction of blood flow through the right ventricular outflow tract and pulmonic valve that resulted from an uncommon cardiac myxoma arising from the right side of the interventricular septum.

Aasha S. Gopal, M.D.
Navin S. Arora, B.S.
Frank C. Messineo, M.D.
New York Hospital Medical Center of Queens, Flushing, NY 11355

4 References

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Citing Articles (3)

Citing Articles

1. 1

   Kiichiro Kumagai, Sadahiro Sai, Masato Endo, Koichi Tabayashi. (2008) Right ventricular myxoma obstructing the pulmonary artery during early childhood. General Thoracic and Cardiovascular Surgery 56:7, 351-353
   CrossRef

2. 2

   Paraskevas S. Brestas, Katerina S. Malagari, Dimitrios A. Kelekis. (2005) Rare right ventricular myxoma detected incidentally on a FAST examination. Journal of Clinical Ultrasound 33:3, 143-145
   CrossRef

3. 3

   Ioannis A Paraskevaidis, Konstantinos Triantafilou, Dimitrios Karatzas, Dimitrios Th. Kremastinos. (2003) Right ventricular multiple myxomas obstructing right ventricular outflow tract. The Journal of Thoracic and Cardiovascular Surgery 126:3, 913-914
   CrossRef