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rarely severe complications like systemic embolism , heart failure , pulmonary hypertension were shown . the signs and symptoms produced by tumors
are related to the size and location of the tumors . when situated in the left side of the heart , they may cause symptoms of left atrial outflow obstruction such as pulmonary hypertension .
we report one case of severe complications of myxoma in adolescents with severe pulmonary hypertension that were recovered by surgical removal .
a 14-year - old boy was admitted to our hospital due to sudden onset dyspnea .
the patient had no past medical history and family history of lung disease and cardiac disease .
two weeks before admission , he suffered from non - productive cough . at the time
, physical findings included a regular heart rate of 98 beats / minutes , a blood pressure of 120/80 mm hg , respiratory rate of 28/minutes represented tachypnea , a body temperature of 36.4 , resting oxygen saturation of 96% .
thoracic auscultation revealed mid - diastolic murmur ( grade ii ) and inspiratory crackle was audible in both lower lung fields .
an electrocardiogram revealed a normal sinus rhythm with right axis deviation , right atrial enlargement .
iu / l , total bilirubin 1.0 mg / dl , pro - brain nitrouretic peptide 6,291 pg / ml .
transthoracic echocardiography to find cause of murmur showed a nodular , mobile , hyperechoic , 4.34  8.11 cm sized left atrial mass ( fig .
2 ) with moderate tricuspid regurgitation suggestive of pulmonary hypertension ( maximal pressure gradient = 81.61 mm hg , pulmonary artery systolic pressure = 101 mm hg ) ( fig .
4 ) , and markedly enlarged right atrium and right ventricle . left ventricular ejection fraction and regional wall motion were normal .
the mass were grossly composed of several friable hemorrhagic nodular mass , measuring 6  5  4.5 cm in size ( fig .
, the mass were composed of setellate myxoma cells , inflammatory cells , much basophilic substance and slit like vessels that were compatible with myxoma .
after 3 days of mass removal , the follow - up echocardiography showed no visible mass lesion ( fig .
3 ) with mild tricuspid regurgitation suggestive of decreased pulmonary arterial pressure ( pressure gradient = 39.37 mm hg , pulmonary artery systolic pressure = 54 mm hg ) ( fig . 5 ) .
the postoperative course was uneventful and the patient remained well during the 3 years follow - up period .
sixty - five percent of cardiac myxomas occur in women and are rare in children.1 ) early diagnosis is difficult because the symptoms of atrial myxoma are frequently nonspecific.1)2 ) large myxomas may remain asymptomatic if tumour growth is very slow .
the heart auscultation can be quite similar to that of mitral valve disease , and may be associated with a tumoral sound .
the most useful examination in the diagnosis is the echocardiogram that is highly sensitive and can diagnose up to 100% of the cases .
although histopathologically benign , cardiac myxomas can cause chronic systemic inflamation , embolism or intracardiac obstructions , leading to increased morbidity.3 ) the symptoms of left - sided heart failure were usual in patients with left atrial myxomas , such as dyspnea on exertion , may progress to orthopnea , paroxysmal nocturnal dyspnea or pulmonary edema because of obstruction at the mitral valve orifice.4)5 ) dyspnea on exertion was the most prominent symptom in our patient .
pulmonary edema was also present but obstruction at the mitral valve orifice was not present .
most etiologies of pulmonary hypertension were chronic obstructive lung disease , pulmonary thromboembolism , mitral stenosis .
nakano et al.6 ) described positive correlation between the size of tumor and pulmonary artery pressure .
the new york heart association function class and mean pulmonary artery pressure were decreased after tumor resection . in our case ,
we report a patient of left atrial huge myxoma presenting with severe pulmonary hypertension in adolescents . a patient was a 14-year - old boy presented with sudden onset dyspnea . 
 transthoracic echocardiographic study revealed the presence of a nodular , 4.34  8.11 cm sized , mobile , hyperechoic mass in the left atrium and severe pulmonary hypertension with tricuspid insufficiency . 
 after surgical therapy , tricuspid regurgitation and pulmonary hypertension was decreased and the patient was stabilized and had an uneventful clinical course .