1| INTRODUCTION
Giant cardiac myxoma is a rare disease that occurs in 3–4% of cases
and is associated with pulmonary embolism in only 0.1% to 0.6% of
cases [1,2,3], which can lead to cardiac arrest, accompanied by
acute heart failure, affecting the patient’s health. We report a case of
a giant right ventricular myxoma being separated into pulmonary thrombus
simultaneously in the process of Transthoracic echocardiography. The
young man underwent intracardiac repair immediately according to
ultrasonic suggestion and was doing well.
2| CASE PRESENTATION
An 18-year-old young man performed physical examination before college
entrance examination. Transthoracic echocardiography (TTE) showed: a
heterogeneous mass was found in the right ventricle, a 40 mm wide
pedicle, occupying 2/3 chamber of
right ventricle, 86 mm×65mm×49 mm in irregular papillary shape.(Fig. 1A–C, Supplementary file:Video 1 and 2). With the heart
beating, one end of the mass swung back and forth to right atrium
through the tricuspid valve, the other end swung to right ventricular
outflow tract simultaneously (Supplementary file: Video 1 and
2). There was no obvious dilation of pulmonary trunk and
its, branches. CDFI: the mass has no obvious blood
flow signals. A small amount of regurgitation at the tricuspid orifice
during systole was observed with 2.4 m/s peak flow velocity and 24 mmHg
pressure gradient (Fig. 1D). The blood flow velocity of
pulmonary artery valve orifice was 0.98m/s during diastole, with no
obvious backflow. (Supplementary file: Video 3) . the patient
suddenly felt the symptoms of chest pain and dyspnea, and TTE
demonstrated the mass maybe a myxoma, and it was detached
simultaneously. Electrocardiogram showed complete right bundle branch
block.
Emergency lung Contrast-enhanced CT and Pulmonary artery CT (CTPA) was
performed for the patient as
following, 7.0 cm×4.3 cm mass with no
contrast enhancement was showed with Contrast-enhanced CT (Fig.
1E) .
About 3.2 cm×1.6 cm nodular filling defect was found in the
right inferior pulmonary artery,
and the blood perfusion in the right lower lung was decreased with CTPA(Fig. 1F) . There has no obvious abnormality with CT of carotid
artery and cerebral artery, there was no lower extremity deep venous
thrombosis with point-of care Ultrasonography. blood gas and biochemical
parameters were normal. Immediately, an emergency
treatment of ”cardiac tumor resection + pulmonary thrombectomy +
tricuspid valvuloplasty” were successfully performed for the patient,
the right ventricular myxoma and pulmonary tumorous embolus were showed
during the operation (Fig. 1G-I) . So many primitive blood
vessels were found in the myxoid matrix, CD34 was strongly positive
stained (Fig. 1J–L ), All the results suggested that the mass
was myxoma. Of course, the patient has been followed-up for half a year
with no signs of recurrence of myxoma and pulmonary embolism.