Ann Clin Neurophysiol.  2021 Oct;23(2):126-129. 10.14253/acn.2021.23.2.126.

Autonomic dysfunction in postoperative primitive neuroectodermal tumor of heart

• Anil AK
• Vanidassane I
• Netam R
• Pushpam D
• Bakhshi S
• Deepak KK

• KMID: 2521891
• DOI: http://doi.org/10.14253/acn.2021.23.2.126

Abstract

We present a patient with a primitive neuroectodermal tumor arising from the right atrium who experienced multiple syncope episodes daily, which had first appeared 1 month after surgery. The symptoms continued to worsen over the course of chemotherapy, and the autonomic function test (AFT) was performed after the 14th chemotherapy cycle. The AFT revealed orthostatic hypotension and reduced baroreflex-dependent sympathetic reactivity. Physical counterpressure techniques were applied with a visual biofeedback intervention, and were found to be effective in reducing the syncope episodes.

Figure

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  Fig. 1. Computed tomography coronary angiography: (A) axial view and (B) coronal view. A large well-defined heterogeneously enhanced soft-tissue mass is seen on the right side of the anterior mediastinum with loss of fat planes and compression of the right atrium and ventricle. The lesion is compressing the inferior vena cava and the lower part of the superior vena cava, with invasion into the right atrium. PNET, primitive neuroectodermal tumor.

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  Fig. 2. (A) Echocardiography recording showing the presence of multiple rhythm-generating foci in the right atrium. (B) Biofeedback therapy during the head-up tilt (HUT) test by sustained pressing and stretching of the lower limb. (C) Biofeedback therapy during the HUT test using a ball compression technique. DBP, diastolic blood pressure; SBP, systolic blood pressure.

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