Surgical management of a giant right atrial myxoma
The present case has been reported in the Journal of Surgical Case Reports.

A 72-year-old female presented to her General Practitioner with a brief history of shortness of breath at rest. Her General Practitioner referred to her local hospital for an outpatient transthoracic echocardiogram, which revealed a right atrium of normal size, with a mobile mass prolapsing through the tricuspid valve. This was suspected to be a large thrombus or a mass of unknown origin. In addition, the echocardiogram showed severe aortic stenosis; the aortic valve was trileaflet with rheumatic appearance.

She was transferred for potential operative management of the right atrial mass. Repeat echocardiography at our hospital confirmed these findings, showing a large echogenic mass filling the right atrium (5.3 × 2.5 cm2) with severe aortic stenosis.

CT cardiac angiogram showed a large filling defect within the right atrium and dense calcification within the aortic valve leaflets. Following median sternotomy, the patient was found to have a large right atrial mass measuring 7 × 4 cm2 occupying the majority of the right atrium with a stalk originating at the junction of the superior vena cava and the right atrium. The apex of that large mass was obstructing the outflow of the tricuspid valve. In addition, there was severe aortic stenosis secondary to calcification of the aortic valve.

That valve was bicuspid but tricommisural as a result of fusion of the left and right coronary cusps. The patient consequently underwent a right atriotomy of the right atrial mass. A low transverse aortomy was also performed and a 25 mm TrifectaTM GT prosthesis was sited.

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