Surgical approach to a left ventricular myxoma guided by transesophageal and epicardial dual-view echocardiography: a case report

Abstract

BackgroundLeft ventricular myxoma is a rare benign cardiac neoplasm. Surgical excision is the treatment of choice, and complete removal is mandatory to prevent late recurrence.Case presentationHere, we report a case of myxoma originating from the anterolateral wall of the left ventricle with a very short stalk. Accordingly, the transaortic and transmitral approaches were considered inadequate; therefore, a transventricular approach was adopted. To minimize the incidence of complications associated with a left ventriculotomy, its length was designed to be as short as possible. To plan a proper ventriculotomy, measurements were taken by the combined use of transesophageal echocardiography and epicardial direct echocardiography.ConclusionsThis method provided a good guide without being a complicated technique. The tumor and its attachment were clearly visualized and completely resected in an en bloc fashion. No recurrence has occurred to date.

Left atrial myxoma with left ventricular myxoma diagnosed by ultrasound examination

“…Through TTE, Qin W et al [ 12 ] observed a LV myxoma attached at the base of the anterolateral papillary muscle in a patient with no history of syncope, palpitation, or dyspnea. Under the guidance of transesophageal echocardiography, Hamasaki A et al [ 13 ] successfully resected the myxoma originating from the left ventricular wall. Transesophageal echocardiography (TEE) can provide more accuracy in the diagnosis of LV myxoma than TTE especially for the detailed information such as the morphology of the mass.…”

“…The TEE features of left ventricular myxoma present as a pedunculated, homogeneous, and mobile mass, which could stem from any part of the left ventricle. [ 13 , 14 , 15 ] During systole, the mass could protrude into the LVOT, leading to the obstruction of LVOT. Mitral valve prolapse and mild mitral regurgitation may be caused by the mass attached to the anterior lobe of the mitral valve.…”

“…Transesophageal echocardiography (TEE) can provide more accuracy in the diagnosis of LV myxoma than TTE especially for the detailed information such as the morphology of the mass. The TEE features of left ventricular myxoma present as a pedunculated, homogeneous, and mobile mass, which could stem from any part of the left ventricle [13,14,15] . During systole, the mass could protrude into the LVOT, leading to the obstruction of LVOT.…”