Myxoma of the mitral valve

Abstract

Only rarely do myxomas originate from the mitral valve. This is the report of a 49-year-old woman presenting with congestive heart failure. . Rarely do they occur in other areas of the heart and only exceptionally are the valves involved. This is our first case of a myxoma involving the mitral valve and, as far as we know, the 23 rd case reported in the literature. Case ReportA 49-year-old black woman was admitted to the hospital with a history of palpitations on efforts and progressive dyspnea over the previous two years. She reported no other symptoms. She had a history of systemic arterial hypertension for five years and her parents had "cardiac problems". On physical examination she had distended jugular veins at 45 o with increased a wave in the venous jugular pulse. Both the carotid pulse and other arterial pulses were normal. On admission, her blood pressure was 160/120mmHg. Parasternal right ventricular heave was palpable in the lower left parasternal border. An apex impulse with a diameter of less than 2 fingertips was palpable and palpable valvar sounds were present at the apex and at the pulmonic area. Loud S1 and P2, as well as S4 from the RV could be heard. An intense protodiastolic murmur, which was interpreted as a tumor plop, could be heard in the mitral area, where a 2+/6+ proto-meso systolic murmur and a diastolic rumble 3+/6+ were also detected. Lungs were clear and there was mild hepatomegaly, which was not painful on palpation. Lower limbs showed signs of chronic venous insufficiency, with mild bilateral ankle edema.Electrocardiogram showed left atrial enlargement and diffuse abnormalities of the ST-T segments, with flattened T waves. Moderate enlargement of the cardiac silhouette, with left atrial and right ventricular enlargement, and signs of venocapillary pulmonary hypertension were present on chest X-ray. Transthoracic echocardiogram showed a dilated left atrium and a mass could be seen attached to the anterior leaflet of the mitral valve. Transesophageal echocardiogram showed a rounded mass, with regular contours and homogenous appearance, which measured 2.5 x 2.2cm and was attached to the atrial part of the anterior leaflet of the mitral valve ( fig. 1). A peak gradient of 24mmHg and a mean gradient of 14mmHg between the left atrium and ventricle were present. Coronariography showed normal coronaries and a radioluscent mass inside the left atrium projecting itself inside the left ventricle during diastole was seen by ventriculography.The patient underwent surgery with cardiopulmonary bypass 20 days after admission. Left atriotomy showed a purple tumor which measured 2.5 x 3.0cm in its largest diameter, had regular borders and a small peduncle which was attached to the anterior leaflet of the mitral valve in its cephalic and basal portion ( fig. 2). The tumor and its attachment to the mitral valve were excised and a bovine pericardium patch was used to repair the valve. Elongated cells (fusiform) and star-shaped cells in a myxomatous estroma, which are typical of myxomas, were seen by ...

Síncope secundario a mixoma gigante del anillo mitral: Reporte de un caso

“…Sin embargo, existen otras localizaciones muy infrecuentes y de mayor riesgo, como la intraventricular izquierda (3-4% de los casos) 1,3 , que puede estar asociada a obstrucción al TSVI y muerte súbita 4 y la relacionada a la válvula mitral. Esta última es de excepcional presentación, con aproximadamente 60 casos reportados en la literatura occidental 5,6,7,8 y sin casos reportados en la literatura nacional, según nuestros registros 9 . Respecto a su presentación clínica, los mixomas pueden manifestarse como un síncope o pre-síncope de esfuerzo en alrededor de 20% de los casos 10,11 , siendo un síntoma ominoso, ya que puede preceder a una muerte súbita.…”

An Unusual Presentation of Cardiac Myxoma; a Case Report and Review of Literature

“…Most atrial myxomas, whether left or right, arise from the atrial septum, usually from the region of the limbus of fossa ovalis. About 10% have other sites of origin, particularly posterior wall, anterior wall and the appendages (in order of frequency) [1].heart valves are extremely rare locations for this tumor to originate, either as the primary site or the site of recurrence [9,10]. When it occurs, it involves both leaflets with the same frequency and usually originates from the atrial side [9].…”