MYXOMA of the heart is found in 0.02 to 0.1 per cent of autopsies, more frequently in the left than in the right atrium. [1][2][3] Myxoma originating in the ventricles is extremely rare: six cases of left ventricular4-7 and three of right ventricular origin8-'0 are recorded in the literature. In addition, two fibromas of the right and three thrombotic pseudotumors of the left ventricle have been described.8 11 The question whether myxomas are fundamentally different from organized and degenerated thrombi12, 13 will not be discussed. One left ventricular tumor has been successfully removed with the aid of cardiopulmonary bypass.5The following is a report of an intracavitary right ventricular myxoma; this appears to be the fourth case described and the first one treated surgically.Case Evidence of congestive heart failure was present at the last admission in January 1961 and was not controlled by strophanthin completely, as shown by the elevated diastolic pressure of the right ventricle at the third cardiac catheterization (table 1). This was performed preliminary to surgical intervention necessitated by the rapid progression of the circulatory failure; in contrast to the former results, the withdrawal curve demonstrated a sharp change of systolic pressure localized at or near the pulmonary valve. Thus the important question about the type of the stenosis, whether valvular or infundibular, was not settled satisfactorily; therefore it was decided to operate with the aid of extracorporeal circulation and hypothermia. Some days prior to operation an attack of exertional syncope with apnea and cardiac arrest occurred.Surgery was performed with the aid of the KayCross heart-lung machine. The outflow tract of the enlarged right ventricle was opened. A large tumor of myxomatous appearance was found obstructing almost completely the pulmonary orifice, protruding partly into the artery itself. The tumor was excised from its attachments to the ventricular wall and the semilunar valve and was entirely removed; it measured 6 by 4 by 3 cm. The ventricle was closed, and the extracorporeal circulation was discontinued after a total duration of 40 minutes. The patient awoke in the operating room and answered several questions; his mean arterial pressure was 75 mm. Hg, the electrocardiogram revealed atrioventricular dissociation.
From 1969 to 1989, 15 patients with an aneurysm of the sinus of Valsalva underwent operative correction. This represents 0.23% of 6515 cardiac operations with cardiopulmonary bypass during that time. There were 8 males and 7 females ranging in age from 15 to 54 years (mean 35.8 years). Symptoms of congestive heart failure, fatigue and palpitation were common. All patients underwent cardiac catheterization including aortography. Associated lesions included aortic valve regurgitation in 6 patients and a ventricular septal defect in 3 patients. The following connections occurred: right coronary sinus to right ventricle (8 patients), right coronary sinus to both right atrium and right ventricle (1 patient), and noncoronary sinus to right atrium (6 patients). The aneurysm was repaired via aortotomy or through the chamber into which it emptied. The aortic valve was replaced in 2 patients. There were no early or late postoperative deaths. Fourteen patients were in NYHA functional class I at late follow-up (range 0.5 to 20.5 years, mean 8.7 years). There have been no recurrences. Our experience supports the concept that early surgical intervention in patients with ruptured aneurysms of the sinus of Valsalva is justified.
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