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

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.