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AUGUST 2001:    Contents

Clin. Cardiol. 24, 570 (2001)

Images in Cardiology

This section edited by Edward A. Geiser, M.D.

A Mitral Valve Myxoma Prolapsing into the Left Ventricular Outflow Tract

Jong-Won Ha, M.D., Ph.D., Se-Joong Rim, M.D., Ph.D., Byung-Chul Chang, M.D., Ph.D.,* Namsik Chung, M.D., Ph.D., Seung-Yun Cho, M.D., Ph.D.

Cardiology Division and *Division of Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea


(A)

(B)

Fig. 1 (A) Multiplane transesophageal long-axis view (130°) showed a mobile mass around the mitral valve characterized by a soft and irregular shape that prolapsed into the left ventricular outflow tract. (B) Color flow imaging showed turbulent flow across the left ventricular outflow tract. AO = aorta, LA = left atrium, LV = left ventricle, RV = right ventricle.

Fig. 2 Macroscopic view of the excised tumor and the anterior leaflet of the mitral valve. Note the soft, irregular, and friable shape of the myxoma attached to the anterior mitral valve leaflet.

Myxoma is the most common cardiac tumor, comprising 50% of all primary cardiac tumors. Myxomas occur most commonly in the left atrium, generally in the region of the fossa ovalis. Myxomas arising from the mitral valve are extremely rare. The common presenting manifestations of cardiac myxomas are symptoms caused by hemodynamic obstruction of the left ventricular inflow tract, systemic embolism, and constitutional symptoms. However, obstruction of the left ventricular outflow tract by cardiac myxoma has not been reported. A 38-year-old woman was admitted for evaluation of a 2-month history of recurrent painful bullae of the fingertips of both hands. The patient was previously healthy and without a significant medical history. On physical examination, no murmur or gallop was heard. The electrocardiogram showed normal sinus rhythm and the chest roentgenogram was normal. Echocardiography was performed to evaluate the possible source of embolism and showed a mass measuring 4.0 3 2.5 cm, located on the anterior leaflet of the mitral valve and prolapsing into the left ventricle and the left ventricular outflow tract (Fig. 1). Doppler echocardiography showed that the peak and the mean systolic pressure gradients across the left ventricular outflow tract were 15.2 mmHg and 8.7 mmHg, respectively. The other cardiac valves and cavities, particularly the interatrial septum, were free of lesions. The patient underwent surgical excision of the mass including the anterior leaflet of the mitral valve (Fig. 2) through a median sternotomy. The mitral valve was replaced with a mechanical prosthesis. The patient subsequently recovered uneventfully.

Reference

  1. Chakfe N, Kretz JG, Valentin P, Geny B, Petit H, Popescu S, Edah-Tally S, Massard G: Clinical presentation and treatment options for mitral valve myxoma. Ann Thorac Surg 1997;64:872­877

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