Abstract
Primary right atrial myxoma is very rare. We report the anesthetic management of an emergent surgical resection of a right atrial myxoma in a 48-year-old female patient. Preoperative echocardiography revealed a right atrial mass of 80×34mm. Arterial blood gas showed marked hypoxemia with an oxygen tension(PaO2) of 52.5mmHg and oxygen saturation of 85.6%. Anesthesia was induced and maintained with propofol, remifentanil and vecuronium. We inserted a Swan-Ganz catheter from the internal jugular vein to monitor pulmonary arterial pressure. The tumor was removed under cardiopulmonary bypass and a patent foramen ovale(PFO), which had not been detected in preoperative transthoracic echocardiography, was found and closed. Arterial blood gas showed normal oxygenation with PaO2 of 569mmHg on FiO2 1.0 after weaning from cardiopulmonary bypass. The intraoperative hemodynamic conditions were stable without cardiopulmonary complications. Right atrial myxoma can produce functional stenosis of the tricuspid valve and cause an increase of right atrial pressure. Thus, right to left shunting can occur through PFO and result in central cyanosis in such patients. Attention must be given to hemodynamic stability and the possibility of tumor obstruction and dissemination in anesthetic management of right atrial myxoma.
