Right ventricle myxoma creating a partial obstruction of the pulmonary infundibulum: case report

A 13-year old female was referred to hospital for severe dyspnoea (stage III NYHA), with an oedema of the face and the lower limbs. She was then steadily putting on weight and gained up to 5 kilogram’s. The situation got worse and the patient referred to cardio vascular surgery. The interview indicated that there has never been a myxomatosis case in her family before.The physical examination revealed a worsening of the general health status and a clinical anaemia. However the pulse was regular, beating at 100 per minute; and the blood pressure was 100/60mmhg. There was no longer an oedema on the face, but the other bilateral pre-tibia oedema was still persistent and taking the gore. The examination also revealed a turgescence of the jugular veins and a hepatomegalia. The heart auscultation allowed a diagnosis of a pulmonary stenosis breath, which was not varying with the changes of postures. The patient did not present any neuro-endocrine clinical signs or any external skin problems.The chest cross section echocardiography revealed a cardiac tumour which implanted on the front lateral side of the right ventricle with an expansion into the pulmonary infundibulum. The patient was operated within 48 hours following her admission. The removal of the myxomatosis was achieved using technique of extra corporeal circulation (CEC). The heart was reached through a median sternotomy followed by a longitudinal right side atriotomy. The tricuspid valve was normal; the tumour was located across the tricuspid orifice. Time cross clamping was 15 minutes. The anatomy pathological examination showed a tumour myxomatosis-like tumour with two lobes measuring 4.2 x 2.3 centimeters. At its top there were zones and muscular tissue and hemorrhagic necrosis. The evolution was simple; the post operation scanning check ups were satisfactoryRight ventricle myxoma protruding into pulmonary artery is exceedingly rare. Obstruction of cardiac cavity is redoubtable complication of myxoma.We emphasize the importance of periodic follow up of young patient with echocardiography allowing early detection of recurrence.