DISCUSSION: Myxomas are the most encountered primary cardiac tumor in adults; the left atrium is the most common site. Newman et al. reviewed 312 cases of right and left atrial myxomas, out of which only two were associated with atrial septal defect [1]. Natarajan et al. has reported one case [2]. Right atrial myxoma is rare and the usual signs are right-sided heart failure and pulmonary embolism [3]. The association between a myxoma and significant right-to-left shunting at atrial level in adults is exceedingly rare [4]. Our patient was cyanotic at the time of presentation because of the right-to-left shunting at the level of atria via PFO as a result of raised right atrial pressure in the background of dynamic obstruction of the tricuspid valve by the right atrial myxoma.