Key result
Initiating CPB before general anesthesia facilitates hemodynamically stable resection of an obstructing right atrial myxoma.
Why the study?
In patients with an obstructive cardiac mass protruding into the right ventricle, inducing general anesthesia carries a concern for cardiovascular collapse from hypotension and bradycardia.
Does establishing cardiopulmonary bypass before general anesthesia prevent cardiovascular collapse in patients with obstructive right atrial myxomas?
Case Report (n=1)
No
Does establishing cardiopulmonary bypass before general anesthesia prevent cardiovascular collapse in patients with obstructive right atrial myxomas?
Initiating cardiopulmonary bypass before general anesthesia is a feasible strategy to prevent acute cardiovascular collapse in patients with large right atrial myxomas obstructing the tricuspid valve.
Pre-induction CPB may prevent collapse in obstructive right atrial myxomas; supports feasibility but remains hypothesis-generating.
We describe a case of establishing cardiopulmonary bypass (CPB) before general anesthesia in a person who has an obstructive right atrial myxoma protruding into the right ventricle (RV). A 27-year-old female endorsed shortness of breath on exertion, dry cough, and palpitations, with a cardiac MRI exhibiting a severely enlarged right atrium (RA) with a 65 mm x 40 mm mass. The mass obstructed the tricuspid valve from closing and extended into the RV, leading to an ejection fraction (EF) of 49%. The obstruction caused concern for cardiovascular collapse due to hypotension and bradycardia that may be provoked by inducing general anesthesia. Under local sedation, the femoral vessels were cannulated, CPB was initiated, and the patient received general anesthesia. A median sternotomy was completed, and traditional CPB was established. After the heart was arrested, the RA was opened, and the mass was resected along with a full-thickness section of the RA. This case report supports preoperative CPB for patients undergoing general anesthesia to correct a cardiac mass that is obstructing central venous return.
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Beisenova et al. (2026) conducted a case report in Right atrial myxoma (n=1). Cardiopulmonary bypass before general anesthesia was evaluated on Hemodynamic stability and successful tumor resection. Initiating cardiopulmonary bypass before general anesthesia allowed for the safe and hemodynamically stable resection of a 65 mm x 40 mm right atrial myxoma obstructing the tricuspid valve.
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