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Original Article | Anaesthesiology | Volume 15 Issue 3, March 2026 | Pages: 1261 - 1265 | India
Anaesthetic Management of Right Atrial Myxoma Extending into the Inferior Vena Cava: A Case Report
Abstract: Background: Cardiac myxomas are the most common benign primary cardiac tumours, most frequently arising in the left atrium. Right atrial myxomas are relatively uncommon and can present unique perioperative anaesthetic challenges, particularly when located near the inferior vena cava (IVC), where they may obstruct systemic venous return and complicate cardiopulmonary bypass (CPB) cannulation. Case Presentation: A 26-year-old male weighing 53 kg presented with progressive exertional dyspnoea. Transthoracic echocardiography (TTE) revealed a mobile right atrial mass measuring approximately 4.8 cm near the IVC?hepatic vein junction. Cardiac magnetic resonance imaging (CMR) demonstrated a lesion measuring 3.3 ? 1.1 cm extending into the supradiaphragmatic IVC. Preoperative investigations revealed concomitant renal impairment (serum creatinine 2.70 mg/dL). Anaesthetic induction was performed with fentanyl, etomidate, and vecuronium. Intraoperative transoesophageal echocardiography (TEE) guided safe bicaval cannulation and confirmed complete tumour excision following right atriotomy under CPB. Outcome: The intraoperative course was uneventful without haemodynamic instability or embolic complications. The patient was successfully weaned from CPB with minimal inotropic support (dopamine 5 μg/kg/min), extubated at 8 hours postoperatively, and discharged on postoperative day 7. Conclusion: Right atrial myxomas extending into the IVC present distinct perioperative challenges including obstruction of venous return, risk of tumour embolisation, and complex cannulation strategy. Maintenance of adequate preload, preservation of systemic vascular resistance, judicious titration of PEEP, and intraoperative TEE guidance are the cornerstones of safe perioperative management.
Keywords: right atrial myxoma, inferior vena cava extension, cardiac anaesthesia, cardiopulmonary bypass, transoesophageal echocardiography, haemodynamic management, tumour embolization
How to Cite?: Dr. Snehal Upadhyay, Dr. Ajita Annachatre. Dr. Nagesh Jambure, "Anaesthetic Management of Right Atrial Myxoma Extending into the Inferior Vena Cava: A Case Report", Volume 15 Issue 3, March 2026, International Journal of Science and Research (IJSR), Pages: 1261-1265, https://www.ijsr.net/getabstract.php?paperid=SR26321154543, DOI: https://dx.dx.doi.org/10.21275/SR26321154543