Right ventricular obstruction caused by giant atrial myxoma

González Argüelles, N.; da Silva Torres, L.; Placer Martínez, J.R.; Taborga Echevarría, A.

doi:10.1016/j.redare.2023.01.002

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B) Vista medioesofágica de 4 cámaras modificada a 180°. En ambas vistas se aprecia el gran tamaño del mixoma en la aurícula derecha y su paso hacia el ventrículo produciendo una significativa ocupación de ambas cámaras cardíacas. C) Imagen de ecografía transtorácica, plano apical de 4 cámaras, realizado tras la resección del tumor y posterior plastia tricuspídea, sin objetivarse masas intracardiacas (flecha). AD: aurícula derecha; AI: aurícula izquierda; M: mixoma; VAo: válvula aórtica; VD: ventrículo derecho; VI: ventrículo izquierdo." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. González Argüelles, L. da Silva Torres, J.R. Placer Martínez, A. Taborga Echevarría" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "González Argüelles" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "da Silva Torres" ] 2 => array:2 [ "nombre" => "J.R." "apellidos" => "Placer Martínez" ] 3 => array:2 [ "nombre" => "A." 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Correa Barrera, B. Gómez del Pulgar Vázquez, P. Sánchez Zamora, E. Alonso Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Correa Barrera" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Gómez del Pulgar Vázquez" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Sánchez Zamora" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Alonso Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621002450" "doi" => "10.1016/j.redar.2021.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621002450?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000033?idApp=UINPBA00004N" "url" => "/23411929/0000007000000001/v1_202302161340/S2341192923000033/v1_202302161340/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Image of the month" "titulo" => "Right ventricular obstruction caused by giant atrial myxoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "62" "paginaFinal" => "63" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. González Argüelles, L. da Silva Torres, J.R. Placer Martínez, A. Taborga Echevarría" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "González Argüelles" "email" => array:1 [ 0 => "nel.gonzalez@scsalud.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "da Silva Torres" ] 2 => array:2 [ "nombre" => "J.R." "apellidos" => "Placer Martínez" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Taborga Echevarría" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obstrucción ventricular derecha por mixoma auricular gigante" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4022 "Ancho" => 2500 "Tamanyo" => 669388 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Mid-oesophageal view of the right ventricular inflow and outflow tract, at 60 ° standard. (B) Modified 4-chamber mid-oesophageal view at 180°. Both views show the large size of the myxoma in the right atrium and its passage into the ventricle causing significant occupation of both cardiac chambers. (C) Transthoracic ultrasound image, apical 4-chamber view, performed after resection of the tumour and subsequent tricuspid plasty, not showing intracardiac masses (arrow). AoV: aortic valve; LA: left atrium; LV: left ventricle; M: myxoma; RA: right atrium; RV: right ventricle." ] ] ] "textoCompleto" => "We present the case of a 56-year-old woman with a personal history of active smoking and several weeks of asthenia, hyporexia, weight loss of 10 kg, palpitations, and dyspnoea. An intracardiac mass was detected on investigation of her symptoms.The patient was scheduled for surgical resection of right atrial myxoma. Intraoperative transoesophageal echocardiography was performed as part of her monitoring and a large multilobulated mass was detected in the right atrium, with a pedicle inserted at the junction between the septum primum and secundum in the posterior area. Part of the mass also protruded into the right ventricle during diastole, obstructing tricuspid filling and the right ventricular outflow tract (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After anaesthetic induction (with 2 μg kg−1 fentanyl, 2 mg kg−1 propofol, and neuromuscular blockade with 1 mg kg−1 succinylcholine), there was increased haemodynamic instability with marked arterial hypotension, conditioned by a fall in peripheral vascular resistance and a decrease in right atrial preload, which facilitated mechanical obstruction of the cardiac tumour over the tricuspid valve and right ventricle. The hypotensive condition improved after administration of fluids, ephedrine, and placing the patient in the Trendelenburg position. The surgery was subsequently performed without incident and the patient was transferred to the critical care unit.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4022 "Ancho" => 2500 "Tamanyo" => 669388 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Mid-oesophageal view of the right ventricular inflow and outflow tract, at 60 ° standard. (B) Modified 4-chamber mid-oesophageal view at 180°. Both views show the large size of the myxoma in the right atrium and its passage into the ventricle causing significant occupation of both cardiac chambers. (C) Transthoracic ultrasound image, apical 4-chamber view, performed after resection of the tumour and subsequent tricuspid plasty, not showing intracardiac masses (arrow). AoV: aortic valve; LA: left atrium; LV: left ventricle; M: myxoma; RA: right atrium; RV: right ventricle." ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000001/v1_202302161340/S2341192923000082/v1_202302161340/en/main.assets" "Apartado" => array:4 [ "identificador" => "70433" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000001/v1_202302161340/S2341192923000082/v1_202302161340/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000082?idApp=UINPBA00004N"]

ISSN: 2341-1929

Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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Vol. 70. Issue 1.

Pages 62-63 (January 2023)

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