A Superinfected Pulmonary Valve Myxoma

Abstract

establishing the diagnosis. However, the final diagnosis relied on pathological investigations. In spite of the benign nature of myxomas, they may inevitably cause valvular dysfunction and secondary pulmonary hyperten-sion and have a significant propensity to embolize the pulmonary artery (1). Pulmonary artery and pulmonary valve myxomas have the common features of right heart system, such as predilections of right ventricular obstruction, right-sided valve insufficiencies, and pulmonary embolism; however, their special characteristic is a smaller size. Pulmonary myxomas could occur isolated or in association with other congenital heart defects or acquired disorders. There were more myxomas arising from the pulmonary valve than from the pulmonary artery or from pulmonary valve and pulmonary artery. Most pulmonary valve myxomas arose from the valve leaflets, and most pulmonary artery myxomas arose from the main pulmonary artery. Because of potential hazards and occasional misdiagnosis, the patients endow an early surgical treatment upon diagnosis (5). Most patients warranted a surgical resection of the myxoma under standard cardiopulmonary bypass, while some patients were operated under normothermic cardiopulmonary bypass or deep hypothermic circulatory arrest. Concurrent procedures to myxoma resection, such as pulmonary valve repair or replacement, or right ventricular outflow tract reconstruction should be performed simultaneously. An early surgical treatment is warranted upon diagnosis because of potential hemodynamic disturbances and predilection of embolization. Most patients have a good prognosis following surgical treatment. References 1. Huang CY, Huang CH, Yang AH, Wu MH, Ding YA, Yu WC. Solitary pulmonary artery myxoma manifesting as pulmonary embolism and subacute cor pulmonale. Am J Med 2003; 115: 680-1. Crossref 2. Blodorn M. Myxoma of the pulmonary valve, respectively of the pulmonary artery. Zentralbl Allg Pathol 1955; 94: 283-9. 3. Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Tumors of the pulmonary artery and veins. Semin Ultrasound CT MR 2012; 33: 580-90. Crossref 4. Barış VO, Uslu A, Gerede DM, Kılıçkap M. Rare cause of dyspnoea: pulmonary artery myxoma. Eur Heart J We report a 63-year-old patient with prior coronary artery bypass surgery and recent history of recurrent hospital admissions for refractory heart failure because of ischemic car-diomyopathy and sustained ventricular tachycardia. The patient underwent ICD implantation through left subclavian vein approach (Medtronic, single chamber, model-Maximo II VR, D284VRC, with 6947 ventricular active fixation lead). This case report describes the first patient, to our knowledge, with defi-brillator lead dislocation after manual lumbar traction for low back pain. The patient was admitted to the emergency service with severe chest pain, and electrocardiography revealed 0.5-1 mm ST-segment elevation in leads DII, DIII, and aVF. After initial evaluation, coronary angiography and percutaneous coronary intervention were immediately ...

Pulmonary valvular and pulmonary arterial myxomas

“…The male patients were much younger than females (27.6 ± 25.8 years vs. 47.0 ± 17.0 years, p = 0.037). The duration of the symptoms ranged from acute onset [20] to several years [14], with a mean of 12.6 ± 19.8 (range, 0.17-60; median, 3.3) months (n = 10) [3,6,7,9,10,12,13,16,21,22].…”

“…Cytologic and microbiologic studies were done in 2 patients: gram positive cocci along with positive blood culture of Abiotrophia streptococci was found in a resected myxoma tissue in one pati ent [22], and blood culture was negative in another [21].…”

“…Perfusion scan showed absence of left lung perfusion in 1 (4.5%) patient [10]. Cardiac catheterization was performed in 6 (27.3%) patients, revealing a fi lling defect [20], serve pulmonary stenosis [21], serve pulmonary stenosis with fi lling defect in the pulmonary valve region [7], moderate aortic valve regurgitation [15], a mobile hyperlucent mass [18], and RVO T obstruction with tumor prolapse [22] in 1 (20%) patient each. Echocardiographic examinations were reported in 13 (61.1%) patients: an attenuated moving mass seen in the pulmonary artery, pulmonary valve or RVOT in 8 (63.6%) patients [3,4,8,14,17,19,22,24], a nodular mass in the RVOT [11], a space-occupying mass in the pulmonary artery [16], a moving mass in the pulmonary artery with insuffi ciencies and stenoses of both the mitral and aortic valves [15], and abnormal fl ow in the pulmonary artery [10], si gns of pulmonary artery hypertension [13] in 1 (9.1%) patient each.…”

“…The myxoma was arising from the pulmonary valve in 12 (54.5%) [4,7,8,11,12,14,[17][18][19]21,22,24], from the pulmonary artery in 9 (40.0%) [3,5,9,10,13,15,16,20,23], and from pulmonary valve and pulmonary artery in 1 (4.5%) patient [6]. In one patient, there were two myxomas arising from the pulmonary artery [20].…”

“…The diagnostic methods depended on preoperative m edical imaging in most cases, while the diagnosis was made by surgical ex ploration in 3 (18.8%) [7,9,21], and by autopsy in 2 (9.1%) patients [6,13]. The dimension of the myxomas was 2.5 ± 1.2 (range, 1-5; median, 3) cm (n =19) [3][4][5][8][9][10][13][14][15][17][18][19][20][21][22]24]. There was no signifi cant difference between the dimensions of pulmonary valve and pulmonary artery (2.4 ± 1.0 cm vs. 3.1 ± 1.2 cm, p = 0.175).…”