SUMMARYCardiac myxoma arising from the anterior mitral leaflet is extremely rare. A 47-yearold Taiwanese male was found to have a 5 × 4 × 3 cm myxoma originating from the atrial side of the anterior mitral leaflet using transesophageal echocardiography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a broad-base stalk arising from the anterior mitral leaflet. To detect the early recurrence, a semiannual follow-up examination using transesophageal echocardiography is needed. (Jpn Heart J 2003; 44: 429-434) Key words: Cardiac tumor, Mitral valve, Transesophageal echocardiography PRIMARY cardiac tumors are uncommon and their autopsy incidence has been calculated to be between 0.0017% and 0.33%. About 50% of these tumors are myxoma which usually arise from the interatrial septum. 1) We report here an extremely rare case of myxoma originating from the anterior mitral leaflet, which was diagnosed and located using transesophageal echocardiography (TEE).
CASE REPORTA 47-year-old male Taiwanese patient was referred to our hospital for the evaluation of intermittent attacks of shortness of breath and palpitations. These symptoms had appeared 1 year previously and were not associated with physical activity, while the severity and frequency of these symptoms worsened in the previous 3 months.His height was 170 cm, body weight 68 kg, blood pressure 114/80 mmHg, pulse rate 90 beats per minute without deficit, respiratory rate 22 per minute, and body temperature 36.2°C. Auscultation revealed a pan-systolic murmur (II/VI) at the apex, a rumble murmur in diastolic phase, and moist rales heard in the inspiraFrom the
Intermittent hypoxia (IH) occurs frequently in patients with obstructive sleep apnoea and can cause ventricular dysfunction. However, whether myocardial inflammation and sodium-hydrogen exchanger-1 (NHE-1) expression play an important role in IH-induced ventricular dysfunction remains unclear. This study aimed to investigate whether short-term exercise provides a protective effect on IH-induced left ventricular (LV) function impairment. Male Sprague-Dawley rats were randomly assigned to 4 groups: control (CON), IH, exercise (EXE) or IH interspersed with EXE (IHEXE). IH rats were exposed to repetitive hypoxia/reoxygenation cycles (2%-6% O₂ for 2-5 s per 75 s, followed by 21% O₂ for 6 h/day) during the light phase for 12 consecutive days. EXE rats were habituated to treadmill running for 5 days, permitted 2 days of rest, and followed by 5 exercise bouts (30 m/min for 60 min on a 2% grade) on consecutive days during the dark phase. IHEXE rats were exposed to IH during the light phase interspersed with exercise programs during the dark phase on the same day. Cardiac function was quantified by echocardiographic evaluation. Myocardial levels of tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and NHE-1 were determined. IH rats showed LV dysfunction characterized by lower LV fractional shortening (LVFS%) and LV ejection fraction (LVEF%). LV dysfunction was associated with higher myocardial levels of TNF-α, IL-6 and NHE-1 mRNA and protein. These changes were not observed in IHEXE rats (P > 0.05 for all). EXE rats showed lower levels of NHE-1 protein than CON rats (P < 0.05). However, the levels of LVFS%, LVEF%, TNF-α and IL-6 protein and NHE-1 mRNA did not differ between EXE and CON rats (P > 0.05 for all). These data indicated that exercise may provide a protective effect on IH-induced LV dysfunction by attenuating IH-induced myocardial NHE-1 hyperactivity.
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