A 2-year-old boy presented with a clinical picture that led him to be hospitalized.
The last month before admission, the patient consulted three times for cough and bronchial obstruction.
She was treated with bronchodilators and antibiotics, without improvement of her symptoms.
The week prior to hospitalization, the patient also had impaired general health, respiratory distress, nausea, abdominal pain and lower limb edema.
Physical examination revealed tachycardia, polypnea, subcostal retraction, gallop rhythm without auscultation of murmurs, hepatomegaly and lower limb edema.
The chest X-ray showed cardiomegaly and pulmonary congestion.
She was hospitalized with a diagnosis of congestive heart failure.
An echocardiogram showed a large tumor in the left atrium of 4.5 per 2.5 cm, suggestive of myxoma, implanted in the lower third of the interatrial septum, which protruded through the left mitral valve with moderate systolic dysfunction;
The patient was admitted with inotropic support and diuretics and scheduled for semi-intensive surgery.
Septum of medial septum was approached through the left atrium via extracorporeal circulation, moderate hypothermia and cardioplegia.
The fossa ovalis was opened identifying the base of implantation of the tumor 1.0 x 0.5 cm approximately, allowing me to completely identify the myxoma by wide resection of the non-tumor septum, residual tumor constituting the myxoma base.
The created atrial defect was closed with an autologous pericardial patch.
The patient was discharged on day 5.
Biopsy was reported as a myxoma with tumor-free surgical margins.
The patient remained asymptomatic, under regular cardiac control with echocardiograms, with no evidence of tumor recurrence one year later.
Two years after surgery, the echocardiogram showed recurrence of a large tumor in the left atrium, implanted in the inferior portion of the atrial septum, with the appearance of myxoma.
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In the second operation, a midline resternotomy was performed and the left atrium was approached through a combined superior and transeptal access, first opening the right atrium and then leaving the left atrial septal position advancing the septum.
The tumor measured 5.0 per 3.5 cm, with a wide implantation base, in which the pericardium patch with which the atrial defect had been repaired in the previous surgery could be appreciated in its central portion.
A large portion of the atrial septum was resected, including the pericardial patch. The created atrial defect was repaired with a polytetrafluoroethylene patch.
Biopsy showed myxoma implanted mostly on the endocardial coated pericardial patch.
Cellular aneuploidy was ruled out by flow cytometry.
The patient was discharged in good condition and remained asymptomatic and without echocardiographic evidence of tumor recurrence three years after reoperation.
