European Journal of Echocardiography 2008 9(1):171-172; doi:10.1016/j.euje.2007.06.019
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
‘Giant fleshy leaflet myxoma’
Ali Reza Moaref1,
Reza Mollazadeh1,*,
Ahmad Ali Amirghofran2,
Bita Geramizadeh3 and
Salma Sefidbakht3
1 Cardiology Department, Nemazee Hospital, Shiraz University of Medical Science, Zand Avenue, P.O. Box: 71435-1414, Shiraz, Iran
2 Cardiac Surgery Department, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
3 Pathology Department, Shiraz Medical School, Shiraz University of Medical Science, Shiraz, Iran
Received 19 May 2007; accepted after revision 20 June 2007; online publish-ahead-of-print 10 September 2007.
* Corresponding author. Tel: +98 (0)917 313 3749; fax: +98 (0)711 6261089. E-mail address: mollazar{at}yahoo.com
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Abstract
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A 25-year-old woman was admitted to the neurology department
because of sudden onset of weakness of her left upper and lower
extremities. Cardiac auscultation revealed an extra sound. Transesophageal
echocardiography showed a huge mobile fleshy mass on the atrial
side of anterior mitral leaflet protruding into the left ventricle
during diastole. A large irregularly shaped mass resembling
a ‘cluster of grapes’ was found on the atrial side
of anterior mitral leaflet. The mass was excised and mitral
valve was repaired. Histology was diagnostic for myxoma. Six
months clinical and echocardiographic follow-up was normal and
did not show any recurrence of tumor.
Keywords: Myxoma; Leaflet; Cardiac; Atrial; Stroke
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Case presentation
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A 25-year-old woman was admitted to the neurology department
because of sudden onset weakness of her left upper and lower
extremities a few hours earlier. She mentioned that she had
transient episodes of vertigo and blurred vision during the
last week which spontaneously ameliorated. She denied any (cocaine
or heroin) drug consumption. She has no family history of early
onset stroke or coronary artery disease. She was afebrile and
her blood pressure was normal. Her pupils' reaction to light
was brisk bilaterally. Cardiac auscultation revealed an extra
diastolic sound. She was well oriented to time, place and person.
Motor power was 3 out of 5 at her left side. ECG showed tachycardia
and was otherwise normal. Brain CT scan showed right hemisphere
infarction in the parietal lobe. The patient was sent to the
echocardiography laboratory for evaluation of the abnormal cardiac
sound. Transthoracic echocardiography showed a large mass on
the mitral valve. Transesophageal echocardiography delineates
the mass as a large mass on the atrial side of anterior mitral
leaflet (
Figure 1,
Movie clip 1 and
2) partially obstructing
the mitral orifice during diastole (
Movie clip 3). The patient
underwent surgery and a large (2
x 2.5 cm) irregularly shaped
mass resembling ‘cluster of grapes’ was found on
the atrial side of anterior mitral leaflet. The mass was excised
and mitral valve was repaired. Histologic examination revealed
stellate tumor cells surrounded by a highly myxoid stroma diagnostic
of myxoma (
Figure 2). Postoperative course was uneventful
and she was still well at six months follow-up.
Myxomas are the most common primary cardiac tumor. They commonly
occur in the left atrium and generally in the region of the
fossa ovalis.
1 Exceptionally they may arise from a cardiac valve.
The tricuspid valve is the most frequent location of these valvular
myxomas
2 followed by mitral, aortic and pulmonary valves.
3 Mitral
valve myxomas were located mainly on the atrial side of valve
(except one report on ventricular side
4) with an equivalent
distribution between the anterior and posterior leaflets.
3 A
review of the literature revealed that a diagnosis of left mitral
myxoma was based on the findings of tumor embolization, suggesting
that a myxoma in the mitral valve produces early embolization
compared to other cardiac myxomas.
3,5 Generally there are two
types of atrial myxoma based on echo examination: (1) those
that are well encapsulated; these are more likely to be encountered
as incidental findings; (2) those that are highly mobile and
amorphous (such as ours,
Movie clip 2) which often results in
symptomatic emboli (most commonly neurologic dysfunction).
3 Diagnosis of this entity is generally made by echocardiography.
Most cases can be diagnosed using transthoracic echocardiography
but may be missed if it measures less than 5 mm in diameter.
Transesophageal echocardiography allows the early detection
of small valvular tumors and may help to characterize better
the location and echo structure of these lesions. In addition,
transesophageal echocardiography can guide the surgical approach
by revealing the integrity and mobility of the valve before
operation whether to perform mitral valve repair or replacement.
Once a presumptive diagnosis of myxoma has been made on imaging
studies, prompt resection is required because of the risk of
embolization or cardiovascular complications.
1
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Supplementary material
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Supplementary material associated with this article can be found in the online version.
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References
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- Pucci A, Gagliardotto P, Zanini C. Histopathologic and clinical characterization of cardiac myxoma: a review of 53 cases from a single institution. Am Heart J (2000) 140:134.[CrossRef][Web of Science][Medline]
- Pessotto R, Santini F, Piccin C, Consolaro G, Faggian G, Mazzucco A. Cardiac myxoma of the tricuspid valve: description of a case and review of the literature. J Heart Valve Dis (1994) 3:344–6.[Medline]
- Chakfe N, Kretz JG, Valentin P, Geny B, Petit H, Popescu S, et al. Clinical presentation and treatment options for mitral valve myxoma. Ann Thorac Surg (1997) 64:872–7.[Abstract/Free Full Text]
- Gosse P, Herpin D, Roudaut R, Malergue MC, Longy M, Baudet E, et al. Myxoma of the mitral valve diagnosed by echocardiography. Am Heart J (1986) 111:803–5.[CrossRef][Web of Science][Medline]
- Chen MY, Wang JH, Chao SF, Hsu YH, Wu DC, Lai CP. Cardiac myxoma originating from the anterior mitral leaflet. Jpn Heart J (2003) 44:429–34.[CrossRef][Medline]
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Abstract
Case presentation
