What question did this study set out to answer?

The aim is to present a case where cardiopulmonary bypass is initiated prior to general anesthesia in a patient with right atrial myxoma.

March 29, 2026Cureus0 citationsOpen Access

Establishing Cardiopulmonary Bypass Before General Anesthesia in a Patient Undergoing Right Atrial Myxoma Resection

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Right atrial myxoma (n=1). Intervention: Cardiopulmonary bypass before general anesthesia. Primary outcome: Hemodynamic stability and successful tumor resection.

KBKamilla Beisenova AVAndrew D. Vogel SPSchafer Paladichuk

Key Result

Initiating cardiopulmonary bypass before general anesthesia allowed for the safe and hemodynamically stable resection of a 65 mm x 40 mm right atrial myxoma obstructing the tricuspid valve.

Key Points

The aim is to present a case where cardiopulmonary bypass is initiated prior to general anesthesia in a patient with right atrial myxoma.
Described a case involving a 27-year-old female with a cardiac mass and obstructive symptoms.
Established cardiopulmonary bypass using femoral vessel cannulation before general anesthesia.
Performed median sternotomy and resection of the myxoma after initiating cardiopulmonary bypass.
The mass obstructed the tricuspid valve and caused reduced ejection fraction of 49%.
Preoperative cardiopulmonary bypass supported safe anesthesia induction, mitigating risks.
Successful resection of the myxoma led to improved cardiac function and symptom relief.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does establishing cardiopulmonary bypass before general anesthesia prevent cardiovascular collapse in patients with obstructive right atrial myxomas?

Population

27-year-old female with an obstructive right atrial myxoma (65 mm x 40 mm) protruding into the right ventricle and mildly reduced ejection fraction (49%).

Intervention

Initiation of cardiopulmonary bypass (CPB) via femoral access under local sedation prior to the induction of general anesthesia.

Outcome

Hemodynamic stability during anesthesia induction and successful resection of the cardiac mass.

Initiating cardiopulmonary bypass before general anesthesia is a feasible strategy to prevent acute cardiovascular collapse in patients with large right atrial myxomas obstructing the tricuspid valve.

Limitations

Increased bleeding risk due to systemic heparin administration before sternotomy
Potential for hemodynamic instability from sudden changes in preload and afterload
Risk of pulmonary complications and airway edema
Patient anxiety and distress from awake cardiopulmonary bypass initiation

Abstract

We describe a case of establishing cardiopulmonary bypass (CPB) before general anesthesia in a person who has an obstructive right atrial myxoma protruding into the right ventricle (RV). A 27-year-old female endorsed shortness of breath on exertion, dry cough, and palpitations, with a cardiac MRI exhibiting a severely enlarged right atrium (RA) with a 65 mm x 40 mm mass. The mass obstructed the tricuspid valve from closing and extended into the RV, leading to an ejection fraction (EF) of 49%. The obstruction caused concern for cardiovascular collapse due to hypotension and bradycardia that may be provoked by inducing general anesthesia. Under local sedation, the femoral vessels were cannulated, CPB was initiated, and the patient received general anesthesia. A median sternotomy was completed, and traditional CPB was established. After the heart was arrested, the RA was opened, and the mass was resected along with a full-thickness section of the RA. This case report supports preoperative CPB for patients undergoing general anesthesia to correct a cardiac mass that is obstructing central venous return.

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