Dr. Hriday Ranjan Roy
THE EVER LARGEST RIGHT
ATRIAL MYXOMA IN NICVD
Mr. Jalal Ahmed- 45 years, a cultivator, hailing
from Cox’s Bazar admitted into NICVD on
21/11/2006 with the complaints of-
1) Intermittent Syncopal attack for 1 month
2) Dyspnoea for 11/2 months
3) Constitutional symptoms for 2 months
The presenting complaints was first noticed
by him 2 months back with low grade
fever- which was irregular and was not
associated with cough or hemoptysis. He
also developed headache, malaise and
some sorts of neurological dysfunction.
For the last 11/2 months, he developed
dysponoea- mostly while he lie on bed, but
did not relieve by sitting upright. It also
occasionally aggravated by exertion. He
has no H/O of asthma or tuberculosis.
During last 1 month, he began to have Syncopal
attack 2/3 times a day. Very occasionally, it
was associated with convulsion, palpitation
and tightness of chest. He has no H/O DM,
HTN or smoking.
For these above complaints, he was admitted
into Cittagong Medical College Hospital on
5/11/2006 and was treated by anti-epileptic
drugs (Discharge Certificate contains no
information). But as the symptoms did not
improve, he was referred to DMCH on
The diagnostic work out done in
DMCH were1) CBC- Hb-13.6 gm%, ESR-58, TC-11,500
DC- N-90%, L-8%.
2) RBS- 4 mmol/L
3) SGPT- 25 U/L
4) S. Billirubin- 1.16 mg%
5) S. Creatinine- 1.64 mg%
6) CXR- normal
7) ICT for malaria- negative
8) CT scan of brain- normal
With the above scenario, he was empirically
diagnosed as a case of cerebral malaria
and was treated as such ( Inj- Jasoquine).
But as the symptoms did not improve, an
echo was done and was diagnosed as a
case of RA myxoma and was referred to
NICVD on 21/11/2006.
General examination on
admission (in NICVD)Appearance- ill looking, confused.
B.P- 100/70 mmHg
Neck veins- engorged
Heart- Diastolic murmur at tricuspid area,
No jaundice, edema, enlarged L. nodes or
Reevaluation was done in Cardiology
Unit-I on 23/11/2006 as followsCXR
Other baseline investigations was
within normal limits
He was then submitted urgently to SU-III for
On 25/11/2006, Under G/A with CPB, open
heart surgery was performed.
ECCT was 96 min, XCT- 52 min.
Per-operative findings and
procedures wereA huge ( 9cm × 7cm) encapsulated mass,
occupying 2/3rd in RA and 1/3rd in RV and
was protruding into RVOT (as in Echo).
It was attached to the limbus of fossa ovalis
by a narrow stalk. Careful removal of the
mass was done to avoid pulmonary
Stages of Operation (Bypass
established, RA- dilated)