A Rare Case of Aortic Valve Myxoma: An Unusual Cause of Embolic Stroke

Abstract

Aortic valve myxoma is an extremely rare cardiac tumour. We describe a 60-year-old woman found to have an aortic valve myxoma and a patent foramen ovale (PFO) presenting as a stroke. In view of the recurrent cerebral ischaemic events, the aortic valve myxoma was surgically removed and the PFO was closed. To the best of our knowledge, this is the first reported case of aortic valve myxoma with a PFO. We also highlight the importance of identifying a possible cardiac source of embolism in a stroke patient and considering this rare tumour as a cause in patients with a cryptogenic stroke.

Aortic Valve Myxoma Presenting with a Stroke: A case report and review of the literature

“…To the best of the authors' knowledge, only 11 cases of aortic valve myxoma have been previously reported in the literature [ Table 1]. [4][5][6][7][8][9][10][11][12][13][14] Interestingly, nine of these previously reported patients were male, as in the current case; this is contrary to the usual female preponderance of myxoma cases. 1,[4][5][6][7][8][9]11,13,14 Overall, six aortic valve myxoma patients were symptomatic, with symptoms largely attributable to distal embolisation and ischaemia, including three cases with stroke, two with myocardial infarctions and one with limb ischaemia.…”

“…1,[4][5][6][7][8][9]11,13,14 Overall, six aortic valve myxoma patients were symptomatic, with symptoms largely attributable to distal embolisation and ischaemia, including three cases with stroke, two with myocardial infarctions and one with limb ischaemia. 4,6,8,[11][12][13] Clinicians should therefore be aware of stroke as a potential presentation of aortic valve myxoma.…”

Aortic valve myxoma at the extreme age: a review of literature

“…On clinical examination, one of the patients presented with embolic myocardial infarction,4 three patients had embolic stroke,6–8 one had embolic occlusion of the abdominal aorta, one patient demonstrated embolic occlusion of the common femoral artery9 and three patients exhibited an incidental finding on TTE 5 10 11. Furthermore, the myxoma was attached to the right coronary cusp in three patients,6 7 11 to the left coronary cusp in two patients (including the present case),10 and to the non-coronary cusp in two patients4 5; two patients exhibited fusion of the left and right coronary cusps 8 9. Valvular myxomas tend to have a smaller cellular component, fewer giant cells and less perivascular cuffing of tumour cells 12…”

A Rare Case of Aortic Valve Myxoma: Easy to Confuse With Papillary Fibroelastoma

“…Unlike a typical fibroelastoma, according to tumor site, we speculated that the tumor was closer to fibroelastoma than other types of tumors. Although aortic valve myxomas are extremely rare in clinical practice, we should at least suspect them in patients with unusual tumor characteristics 15). Nevertheless, the clinical diagnosis of cardiac myxoma is often challenging, and distinguishing myxoma from a vegetation or thrombus by echocardiography is often difficult.…”