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Multiple intramural right atrial myxomas encountered incidentally during coronary artery bypass surgery.

A 64-year-old man underwent coronary artery bypass surgery at Wellington Hospital. On opening the pericardium, we found a yellowish thickening of the right atrial appendage at the usual cannulation site (Figs. 1 and ​and2),2), encroaching on the atrioventricular groove. Three additional areas on the right atrial wall were thickened and abnormal (Fig. 3). Samples of all these lesions were sent for immediate frozen-section biopsy and were reported to be myxoma. The patient had no history of familial or recurrent myxoma, including no history of the stigmata associated with Carney's complex. We performed adequate excision of these lesions and more limited excision of the intramural mass encroaching upon the atrioventricular groove. All biopsy lesions were later reported, on histologic examination, to be myxoma (Fig. 4). It is of interest that intraoperative transesophageal echocardiography was unable to reveal these thickened lesions in the right atrial wall or within any other chambers of the heart. The patient made a good recovery after the operation and was discharged on the 5th postoperative day. The results of cardiovascular magnetic resonance performed at the 6-month and 1-year follow-up visits were unremarkable. 
 
 
 
Fig. 1 Intraoperative photograph of intramural atrial myxoma at the right atrioventricular groove. An extension into an epicardial fat pad can be seen as yellowish-white tissue on the right ventricle. The white arrow indicates myxoma, the black arrow ... 
 
 
 
 
 
Fig. 2 Pathology specimen of myxoma from the vicinity of the interatrial groove, after near-total resection. 
 
 
 
 
 
Fig. 3 Pathology specimens of multiple small myxomas resected from the right atrial surface. 
 
 
 
 
 
Fig. 4 Histologic analysis of all resected specimens showed features characteristic of myxoma. Spindle-shaped cells in a loose matrix are very characteristic of myxoma in both low and high magnifications. A) At the top of the figure is a more stromal ...