Origin of atrial fibrillation from the pulmonary veins in a mitral patient.

outflow obstruction, is rare, and the presence of 2 myxomas originating in the right ventricle involving both right ventricular inflow and outflow tract has never been reported. Symptoms may be variable and are determined by the tumor location and size. Inflow or outflow obstruction, embolism, syncopal episodes, and arrhythmias are the most common. After the diagnosis of acute right ventricular obstruction resulting from a cardiac mass, prompt surgical resection is indicated because of imminent embolization and inflow or outflow obstruction, resulting in sudden death. Several surgical techniques have been suggested, but in each case it depends on the site of the tumor. This case report highlights the fact that right ventricular outflow obstruction associated with episodes of syncope during exercise may be related to a cardiac myxoma, despite the right-sided, very low incidence of this tumor. Transesophageal echocardiography accurately identifies the presence of right ventricular multiple tumors and aids the surgical procedure.