Intraoperative transesophageal echocardiography in large heart tumors

A 46-year-old woman known to have an asymptomatic left atrial tumour suddenly developed dyspnoea, tachycardia (up to 140 beats/min) and a fall in systolic blood pressure to 80 mm Hg, 12 days after an extensive radical operation for metastatic ovarian carcinoma. Echocardiography demonstrated a large left atrial tumour which impaired left ventricular filling. A previously healthy 42-year-old man reported increasing exertional dyspnoea with retrosternal feeling of tightness. A 2/6 systolic murmur was audible over the cardiac apex, a 3/6 diastolic murmur heard maximally over the 2nd intercostal space, and there was a third heart sound. The chest X-ray film demonstrated pulmonary venous congestion and there was an enlarged P-wave in the ECG suggesting left-atrial enlargement. Echocardiography revealed a myxoma-like tumour in the left atrium. A thoracotomy was performed in both patients. Using intra-operative transoesophageal echocardiography, the attachment of the tumour (in both instances a myxoma), the course of the operation and, after tumour removal, normal valvar and cardiac function were demonstrated. In case 2, the echocardiographic findings justified an atypical approach via the right atrium. In both patients removal of the tumour and the postoperative course were without complication.