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Heart & Cardiology/Surgery for right atrial myxoma



I recently found out that I have a right atrial myxoma. In my case, it seems to cause mainly hematological and immunological alterations (deranged blood coagulation, GI bleeding, proliferation of  B -lymphocytes and vasvulitic-like symptoms/ dermatological signs and poor acral microcirculation) rather than classic heart symptoms. However, some echoes in the past did suggest increased RA pressure (dilated/congested proximal vena cava inf. And hepatic veins) - but at that time, the cause could not be figured out, and the finding was not constant, but recurred regularly.
Due to above mentioned symptoms someone finally suggested doing a transesophageal echo and this clearly showed a small myxoma in the right atrium, nearby the entrance of the vena cava into the RA.

Now, I have some questions (I havent had consultation with heart surgery yet):
1. How long does surgery for myxoma take?
2. Is there an increased risk for complications due to resternotomy? (i had a median sternotomy in the past for a mediastinal mass)
3. How could the finding by transthoracic echo be explained when it did not show the tumor?
4. I am 26, and have already severe health issues unrelated to the myxoma. However, I read that cafe au lait spots and adrenal overactivity (manifest or subclinical) can go together - i do have 2big and 4 small cafe au lait spots and some unexplained subclinical adrenal issues. Could there be a connection?
5. Have you ever had a patient with myxoma that presented with immunological/rheumatological symptoms? If yes, did surgery cure the symptoms?

Thank you very much.


ANSWER: Hi Sarah,
Please read my answer here:
Hope this helps,
Dr T

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your in depth explanation.

What do you consider as "several hours" - 3-4h? my sternotomy took about 3 hours but I wasnt on cardiopulmonary bypass which I'd assume is necessary for the resection of the myxoma..?

Could you think of an explanation as to why  the transthracic echo first showed a dilated/congested vena cava/hepatic veins (but noi apparent cause), the second one was normal, and the third showed again a dilated/congested vena cava.?
Can there be an intermittent obstruction due to the myxoma (i think i read they can be quite mobile)?
Because of the normal one in-between and the lack of an apparent explanation of the finding by TTE (and my young age) nothing was done until I began to present with systemic symptoms and someone reviewed the history.

Regarding possible heart symptoms: i have shortness of breath and tachycardia when climbing stairs as well as acrocyanosis, raynauds and livedo reticularis. actually, this was the reason for performing an echo in the first place). Yet, as nothing was found these symptoms were attributed to a presumed autonomic neuropathy. Also, drawing blood became more and more difficult. I also had a central venous catheter that time, and i couldnt use it any more and it had to Be removed due to recurrent formation of little blood clots in the catheter line.
Could these things actually be explained by the effects of the tumor?
Thank you very much!

Hi Sarah,
1. Probably
2. An answer could the myxoma is mobile and sometimes obstructs the flow back into your heart, or a piece/blood clot broke off w/o causing problems such as a pulmonary embolism (rare/unlikely).
3. Maybe.
Hope this helps,
Dr T

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