Myxoma is a benign, gelatinous, generally smooth but sometimes brittle, conjunctival tumor that most often develops in the heart and more precisely:

• left atrium in 75 % of cases; they are often attached to the cardiac wall by a pedicle, and move freely within the blood flow. As a result, the tumour can enter and exit through the adjacent mitral valve and generate signs and symptoms of mitral stenosis.
• right atrium in 20 % of cases; in that case, the tumor can go through the tricuspid valve and cause signs of tricuspid stenosis or insufficiency
• ventricle in 5 % of cases

Myxomas can also develop in other parts of the body. For example, in the Carney complex (see this term) where multiple myxomas appear not only in the heart but also in the skin, mammary glands, oropharynx (behind the uvula) or female genitalia.

While standing, the patient with a myxoma in the left atrium may experience dyspnea or syncope (sometimes seizures) as the gravity forces the myxoma to pass through the opening of the mitral valve, which blocks blood flow to the heart. Lying supine usually moves the myxoma away from the valve and improves the symptoms.

Other possible complications include:

• cardiac rhythm disorders
• embolic accidents (brittle tumor)
• chronic inflammatory syndrome, sometimes accompanied by weight loss and arthralgia
• sudden death

Anesthetic implications:

echocardiography; slow induction as for a mitral stenosis; be prepared for the management of acute mitral or tricuspid obstruction.

References : 

-         Lezzi F, Quarti A, Capestro A, Pozzi M.
Obstructive neonatal atrial myxoma.
Int J Surg Case Rep 2017;37:579.

-        Singh G, Shah R, Patel K, Mishra A.
Anaesthetic implications of right atrial myxoma in a premature infant.
Indian J Anaesth 2022 ; 66 :307-9

Updated: October 2022