IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Primary Giant Cardiac Lymphoma Occupying Right Atrium
Takeki Ohashi, MD,
Tuyoshi Yoshida, MD,
Fujihiro Oka, MD,
Kikuko Tazawa, MD,
Yasutaka Hirai, MD,
Nozomu Oyoshi, MD
Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, Kasugai City, Aichi, Japan
Takeki Ohashi, MD, Tel: +81 568 51 8711, Fax: +81 568 51 7115, Email: o-takeki{at}nagoya.tokushukai.or.jp, Cardiovascular Surgery Department, Nagoya Tokushukai General Hospital, 2-28-1, Kozoji-cho, Kasugai-city, Aichi, Japan 487-0013.
A 78-year-old man was admitted with dyspnea and cyanosis. Chest radiography showed severe cardiomegaly. Echocardiography (Figure 1-1
) revealed a large tumor in the right atrium, extending into the right ventricle, and associated with massive pericardial effusion. Right atrial angiography showed a mass obstructing intraatrial blood flow into the right ventricle. Coronary angiography demonstrated total occlusion of the mid-portion of the right coronary artery with good distal collateral flow from a normal left coronary artery. Emergency surgery was required on the day of admission. Cardiopulmonary bypass was established with venous cannulation via the femoral vein because of the large right atrial tumor. Copious blood was observed in the pericardial cavity. The massive right atrial tumor, extending to the right ventricle and involving the tricuspid valve and right coronary artery, was resected, including the free right atrial wall and inflow part of the right ventricle from the tricuspid valve to the right coronary artery. The resected tumor measured 12 x 7 x 6 cm and weighed 230 g (Figure 1-2). A valve prosthesis was attached around the right ventricular inflow, including the free wall of the right ventricle (Figure 1-3). The right atrium was reconstructed (Figure 1-4) using bovine pericardial patches, by suturing anteriorly around the cuff of the valve inferiorly to the inferior vena cava, and laterally to the atrial septum and superior vena cava. All procedures were conducted without cardioplegic arrest. The postoperative course was satisfactory, and 2 months after the operation, the patient was discharged and walked unaided. Pathology of the tumor showed a B-cell type malignant lymphoma. The patient was followed up by an oncologist who advised no chemotherapy; he died from pneumonia 8 months after the operation.
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Figure 1. Transesophageal echocardiography showing a large mass occupying the right atrium and the inflow portion of the right ventricle (upper left). Resected tumor (upper right). Tricuspid valve replacement after tumor resection, including the free right atrial wall, tricuspid valve and inflow part of the right ventricle (lower left). Reconstruction of the free right atrial wall (lower right).
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Asian Cardiovasc Thorac Ann 2009;
17:437-438
© 2009 by SAGE Publications
DOI: 10.1177/0218492309338094
