Hemodynamic management of a patient with a huge right atrium myxoma during thoracic vertebral surgery A case report

Rationale: Myxoma is the most common primary benign cardiac tumor, which could lead to some fatal complications because of its strategic position. Patient concerns: The patient was admitted to our hospital due to sudden onset of palpitation, chest tightness, mild fever, night sweats, accompanied with bilateral lower extremities adynamia, and paralysis for 5 days, but no obvious syncope and edema. Diagnoses: Transthoracic echocardiography showed a giant mobile myxoma (72 x 58mm) in the right atrium (RA). Magnetic resonance imaging revealed an erosive space-occupying lesion located between the first and third thoracic vertebrae. Interventions: Thoracic vertebral lesions were resected immediately to rescue the incomplete paraplegia. After the patient was placed in the prone position, significant hemodynamics changes were observed due to the displacement of the huge RA myxoma. Outcomes: Stable hemodynamics was maintained during the operation through control of fluid infusion combined with vasoactive drugs. Lessons: Change in body position may lead to obstruction of intracardiac blood flow in patients with giant myxoma. This clinical manifestation is rarely reported.