Sporadic cardiac myxoma involving all the cardiac chambers.

A thirty-two-year-old woman was admitted with complaints of fever, palpitations, and syncopal episodes for the last 3 months. On examination she was found to have elevated jugular venous pressure and pallor. Cardiovascular examination revealed loud first and second heart sounds with mid diastolic murmurs in mitral and tricuspid areas. ECG showed incomplete right bundle-branch block pattern. Transthoracic echocardiogram showed 4.5 × 4.6 cm size heterogenous intracardiac mass in right atrium (RA) attached to interatrial septum (Figure 1 and Movie I in the online-only Data Supplement). Two masses of similar echo texture were noted, 1 in the left atrium (LA; size 2.9 × 1.9 cms) attached to interatrial septum and another in left ven-tricular out flow tract (LVOT; size 0.9 × 1.4 cms) attached to interventricular septum (Figure 2 and Movie II in the online-only Data Supplement) causing mild LVOT obstruction (Doppler peak gradient of 21 mm Hg; Figure 3). The atrial masses were prolapsing into the ventricles during diastole, obstructing the tricuspid and mitral orifices. The patient was managed surgically. Intraoperatively a large mass in RA protruding into the right ventricle body and out-flow tract (Figure 4), was noted and another mass measuring 1 × 0.8 cms was noted in the right ventricle in between the trabeculae. All the intracardiac masses were excised, and the patient had uneventful recovery. Postoperative echocardiography did not show any residual masses in Figure 1. Transthoracic echocardiogram in apical 4-chamber view showing tumor masses in right atrium (large arrows) and left atrium (small arrows). LV indicates left ventricle; and RV, right ventricle. Figure 2. Transthoracic echocardiogram in parasternal long-axis view showing tumor masses in left ventricular outflow tract (large arrows) and left atrium (small arrows). Figure 3. Transoesophageal echo Doppler study showing peak gradient of 21 mm Hg across the left ventricular outflow tract (LVOT).