Primary cardiac tumors are rare, and myxomas account for the majority of benign neoplasms. In uncommon cases, large myxomas can cause significant intracardiac hemodynamic disturbances that mimic valvular defects, heart failure, or thromboembolic conditions. Timely diagnosis and appropriate surgical management are essential to prevent life-threatening complications.

Aim. To analyze the features of intracardiac hemodynamics in patients with myxomas causing chamber obstruction and to present own clinical observations for evaluating the effectiveness of surgical tactics.

Materials and methods. Two clinical cases of large cardiac myxomas causing obstruction of the left and right heart chambers are presented. A comprehensive assessment of clinical symptoms, instrumental studies (transthoracic and transesophageal echocardiography, CT angiography), and surgical outcomes was performed. Histopathological verification of the diagnosis was obtained through microscopic examination of the resected tumors.

Results. In both patients, giant myxomas with pronounced outflow obstruction were identified, manifesting with severe dyspnea, pulmonary hypertension, and signs of congestive heart failure. Both patients underwent successful surgery: in the first case – a left atrial myxoma prolapsing into the left ventricular outflow tract, and in the second – a multilobular right atrial myxoma obstructing the inferior vena cava and the right atrioventricular orifice. The use of parallel cardiopulmonary bypass and individually selected surgical access ensured complete tumor excision and stabilization of hemodynamics without postoperative complications. Histopathological examination confirmed the benign nature of the tumors.

Conclusions. Giant cardiac myxomas causing hemodynamically significant chamber obstruction can lead to severe heart failure and pose an immediate threat to life. Echocardiography remains the leading diagnostic method that allows determining the size, location, and mobility of the tumor. Surgical resection with subsequent histopathological verification is the treatment of choice, providing high survival rates and a minimal risk of recurrence.