A Case of Emergency Surgery for a Huge Primary Right Atrial Malignant Lymphoma with Right Ventricular Failure and Shock

(Division of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan)

Shigeru Sakamoto Daisuke Sakamoto
We report a rare case of a 70-year old woman who suffered right ventricular failure and shock with a comparatively rapid course due to a huge primary right atrial malignant lymphoma occupying the right atrium. She had undergone mitral valve replacement and tricuspid valve annuloplasty due to combined valvular disease 12 years previously, and she had been treated for liver cirrhosis due to hepatitis C. The transthoracic echocardiography and the computed tomography scan revealed a huge tumor occupying the right atrial cavity and incarceration into the tricuspid valve ring. We performed an emergency operation to resect the heart tumor. As the tumor strongly adhered to the free wall of the right atrium and the tricuspid valve ring, we performed complete resection of the right atrial free wall and tricuspid valve. Therefore, we performed tricuspid valve replacement with a bioprosthesis, and reconstruction of the right free wall with an EPTFE sheet. The pathological examination of the tumor was consistent with malignant lymphoma of B-cell origin. These surgical procedures were effective to reduce acute right heart failure due to severe tricuspid valve regurgitation, but she died 3 months after surgery because of liver failure due to cirrhosis. Even though the operation was not curative, it might have been effective for preventing sudden death and acute right ventricular heart failure due to incarceration into the tricuspid valve ring of the huge right atrial tumor.
  Jpn. J. Cardiovasc. Surg. 43:27-31(2014)

Keywords:primary cardiac malignant lymphoma;right heart failure;liver cirrhosis;incarceration into the tricuspid valve ring