Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000100010
Brazilian Journal of Anesthesiology
Clinical Information

Mixoma de átrio direito associado a cor pulmonale agudo: relato de caso

Right atrial myxoma associated with acute cor pulmonale: case report

Michelle Nacur Lorentz; Ektor Corrêa Vrandecic; Leonardo Ferber Drumond; Raquel Reis Soares

http://dx.doi.org/10.1590/S0034-70942008000100010 Braz J Anesthesiol, vol.58, n1, p.69-72, 2008
PDF Português
PDF English
Downloads: 0
Views: 1029

Resumo

JUSTIFICATIVA E OBJETIVOS: Os mixomas atriais são a forma mais comum de tumor intracardíaco primário. Apesar de serem tumores de comportamento benigno, recomenda-se que sejam retirados tão logo diagnosticados devido à possibilidade de embolização do tumor com suas nefastas conseqüências. O objetivo do presente relato foi apresentar um caso de tumor intracardíaco com localização rara (intra-atrial direito) que apresentou embolização intra-operatória de parte do tumor e alertar os anestesiologistas para a possibilidade dessa complicação, além de discutir a conduta anestésica. RELATO DO CASO: Paciente do sexo masculino, 42 anos, portador de grande massa em átrio direito, submetido à retirada do tumor. A indução da anestesia foi feita com etomidato, fentanil e brometo de rocurônio e a manutenção, com isoflurano e fentanil. No intra-operatório o paciente apresentou quadro de cor pulmonale agudo em virtude da embolização de parte do tumor, sendo realizadas medidas de suporte e iniciada rapidamente a circulação extracorpórea. O restante da operação transcorreu bem e o paciente recebeu alta no sétimo dia pós-operatório em boas condições. CONCLUSÕES: Apesar do mixoma intracardíaco ser um tumor de características benignas, ele pode estar associado a complicações graves e às vezes fatais. O conhecimento da doença é importante para que o anestesiologista possa manusear de modo adequado esses pacientes, bem como diagnosticar e tratar as possíveis complicações intra-operatórias.

Palavras-chave

COMPLICAÇÕES, COMPLICAÇÕES, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Atrial myxomas are the most common type of primary intracardiac tumors. Although they are benign, it is recommended its immediate removal as soon as the diagnosis is confirmed, since they are associated with tumor embolization and their harmful consequences. The objective of this report was to present the case of an intracardiac tumor of rare location (right atrium) that developed intraoperative embolization and to alert anesthesiologists for the possibility of this complication, besides discussing the anesthetic conduct. CASE REPORT: A male patient, 42 years old, presented with a large mass in the right atrium, being scheduled for removal of the tumor. Anesthetic induction consisted of ethomidate, fentanyl and rocuronium bromide and it was maintained with isoflurane and fentanyl. Intraoperatively, the patient developed acute cor pulmonale secondary to tumor embolization, with the immediate institution of support measures and cardiopulmonary bypass. The remaining of the surgery was uneventful and the patient was discharged on the 7th postoperative day in good conditions. CONCLUSIONS: Although intracardiac myxoma is a benign tumor, it can be associated with severe and even fatal complications. Knowledge of the disease is important for the proper management of those patients by the anesthesiologist, as well as to diagnose and treat possible intraoperative complications.

Keywords

COMPLICATIONS, COMPLICATIONS, Diseases

References

McCoskey E, Mehta J, Krishanan K. Right atrial myxoma with extracardiac manifestations. Chest. 2000;118:547-549.

Reynen K. Cardiac myxomas. N Engl J Med. 1995;333:1610-1617.

Mittle S, Makaryus A, Boutis L. Right-sided myxomas. J Am Soc Echocardiogr. 2005;18:e14-e17.

Ipek G, Erentug V, Bozbuga N. Surgical management of cardiac myxoma. J Cardiac Surg. 2005;20:300-304.

Niarchos C, Frangides C, Kouni S. Ascites and other extracardiac manifestations associated with right atrial myxoma: a case report. Angiology. 2005;56:357-360.

Karagounis A, Sarsam M. Myxoma of the free wall of the right ventricle: a case report. J Cardiac Surg. 2005;20:73-76.

Van Der Heusen FJ, Stratmann G, Russell I. Right ventricular myxoma with partial right ventricular outflow tract obstruction. Anesth Analg. 2006;103:305-306.

Vieillard-Baron A, Schmitt JM, Augarde R. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: Incidence, clinical implications, and prognosis. Crit Care Med. 2001;29:1551-1555.

Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest. 1997;111:209-217.

Vieillard BA, Schmitt JM, Augarde R. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: Incidence, clinical implications, and prognosis. Crit Care Med. 2001;29:1551-1555.

5dd6d0390e8825486713f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections