Combined coronary artery bypass grafting and surgical resection of right atrial myxoma complicated with pulmonary embolism

Although the association between right atrial myxoma and pulmonary embolism is rare, it has been recognized for many years. This condition is fatal unless surgical intervention is performed for resection of right atrial mass and pulmonary embolectomy. A 68 years old diabetic, hypertensive male patient was admitted to our hospital with severedy spnea and chest pain. An echocardiogram and pulmonary CT angiography revealed right atrial mass and pulmonary embolism. Further more, coronary angiography was done and showed a three vessels disease. Complete surgical removal of the right atrial myxoma and parts of the tumor embolectomy from the right pulmonary artery were successfully performed combined with coronary artery bypass grafting to LAD, obtuse marginal and diagonal branches. Histological examination of the primary tumor as well as the embolus confirmed the diagnosis of benign myxoma. The patientwas discharged after 15 days of his successful operation. We report this case, as it is unique because of the rarity of the combined surgery of right atrial myxoma complicated with pulmonary embolism and coronary artery bypass grafting. Si bien la asociacion entre el mixoma auricular derecho y la embolia pulmonar es poco frecuente, se conoce su existencia desde hace anos. La condicion es fatal salvo si se realiza una intervencion quirurgica para la reseccion de la masa auricular derecha y una embolectomia pulmonar. Ingresa a nuestro hospital un paciente masculino diabetico e hipertenso de 68 anos con disnea severa y dolor de pecho. Un ecocardiograma y una angioTac de pulmon revelan un masa auricularderecha y una embolia pulmonar. Ademas, la coronario angiografia realizada identifica enfermedad en tres vasos. Se realiza con exito la reseccion quirurgica completa del mixoma auricular derecho y parte de la embolectomia tumoral de la arteria pulmonar derecha junto con un bypass de la arteria coronaria a la descendente anterior, la marginal obtusa y las ramas diagonales. El examen histopatologico del tumor primario y de la embolia confirman el diagnostico de mixoma benigno. El paciente fue dado de alta 15 dias despues de la exitosa operacion. Publicamos este caso ya que es unico porque es poco frecuente es combinar la cirugia de un mixoma auricular derecho complicado por una embolia pulmonar con una cirugia de bypass de la arteria coronaria. Apesar da associacao entre mixoma auricular direito e embolia pulmonar ser pouco frequente, sua existencia e conhecida ha anos. A condicao e fatal salvo se realizamos uma intervencao cirurgica para a reseccao da massa auricular direita e uma embolectomia pulmonar. Ingressa ao nosso hospital um paciente masculino diabetico e hipertenso de 68 anos com dispneia severa e dor no peito. Um ecocardiograma e um angioTAC do pulmao revelam uma massa auricular direita e uma embolia pulmonar. Alem disso, a coronario angiografia realizada identifica comprometimento de tres vasos. Realiza-se com exito a reseccao cirurgica completa do mixoma auricular direito e parte da embolectomia tumoral da arteria pulmonar direita junto com um bypass da arteria coronaria adescendente anterior, a arteria obtusa marginal e os ramos diagonais. O exame histopatologico do tumor primario e da embolia confirmam o diagnostico de mixoma benigno. O paciente recebeu alta 15 dias depois da exitosa operacao. Publicamos este caso por ser unico devido a pouco frequencia em combinar a cirurgia de um mixoma auricular direito complicado por uma embolia pulmonar com uma cirurgia de bypass da arteria coronaria.

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