A case of neonatal right atrial mucinous tumor complicated with congenital heart disease

1.Clinical data

Child,female,age 26 days (premature birth at 7 months gestational age),body weight 2 8 kg .Due tothe discovery of heart murmurs,recurrent lung infections,and mild cyanosis on the lips for 20 days,he was admitted to the hospital on October 8,2014.Physical examination:No cyanosis on the lips .The precordial area is full,with no abnormal apical pulsation,located in the 5th intercostal space onthe left edge of the sternum .Left clavicle midline inner side 1.0 cm .Palpation of the apex of theheart shows the same position as before,and diastolic murmurs can be heard in the precordial area .The second heart sound in the pulmonary valve area is enhanced .A grade III/6 full-term rumblingmurmur can be heard in the second intercostal space on the left edge of the sternum .Cardiacultrasound prompts:①Right atrial mucinous tumor;②Congenital heart disease:atrial septal defect,patent ductus arteriosus (Figure 1A).Clinical diagnosis:①Right atrial mucinous tumor;②Congenital heart disease:atrial septal defect,patent ductus arteriosus .On October 10,2014,rightatrial myxoma removal,atrial septal defect repair,and arterial catheter ligation were performed undergeneral anesthesia and cardiopulmonary bypass .Intraoperative findings:The size of the right atrialmass is approximately 1.5 cm ×1. 0 cm ×0. 6 cm,oval shaped milky white semi transparent,with incomplete capsule and fragility (Figure 1A);Central type atrial septal defect,with a size ofapproximately 5 mm x 3 mm and an arterial catheter of approximately 2 mm x 3 mm .The tumor wascompletely removed during surgery and the cardiac malformation was also relieved .Postoperativepathological diagnosis of the tumor:mucinous tumor.Successfully recovered after surgery,followedup for six months,with no recurrence of mucinous tumors or pneumonia .

2.Primary cardiac tumors are mostly mucinous tumors,which are true tumors with lowermalignancy.There have been no successful surgical cases of neonatal cardiac mucinous tumors .Thepatient is a premature newborn with immature heart and important organs,and a relatively light bodyweight (only 2.8 kg),with poor tolerance to extracorporeal circulation and cardiac surgical trauma .However,due to the myxoma located near the tricuspid valve,which fluctuates with blood flow,itmay cause acute tricuspid valve infarction at any time,leading to the death of the child;In addition,due to the inherent characteristics of mucinous tumors,they are prone to detachment,leading toseeding metastasis or acute pulmonary artery infarction;And the child also has congenital heartdisease (atrial septal defect and patent ductus arteriosus),leading to recurrent lung infections .Giventhe above risks,early surgical treatment is necessary once diagnosed,including removal of cardiacmyxoma,repair of atrial septal defect,and ligation of arterial catheters .The surgery went smoothly,and the patient recovered well after surgery.After six months of follow-up,there was no recurrenceof mucinous tumors or pneumonia .