Asian Annals
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Vinay Krishna
Pramod Sharma
Pankaj Srivastava
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dayal, A.
Right arrow Articles by Srivastava, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Dayal, A.
Right arrow Articles by Srivastava, P.
Asian Cardiovasc Thorac Ann 2000;8:262-263
© 2000 Asia Publishing EXchange Pte Ltd

CASE STUDY

Anterior Mitral Leaflet Myxoma

Aruneshwari Dayal, MCh, Jeewan Lal Sahni, MCh, Mohammad Ahmad, DM, Vinay Krishna, MCh, Rama Niwas Pandey, MD, Pramod Sharma, MCh, Pankaj Srivastava, MCh

Department of Cardiovascular and Thoracic Surgery
L.P.S. Institute of Cardiology
G.S.V.M. Medical College
Kanpur, India
For reprint information contact: Aruneshwari Dayal, MCh Tel: 91 512 21 4269 Fax: 91 512 54 7978 Department of Cardiovascular and Thoracic Surgery, L.P.S Institute of Cardiology, G.S.V.M. Medical College, Nawab Ganj, Kanpur 208002, India.

   Abstract
TOP
 Abstract
Introduction
 Case Report
 Discussion
 References
 
A 19-year-old man was admitted with a 6-month history of palpitations and dyspnea. A sessile myxoma of the anterior mitral valve leaflet was radically excised. Heart block developed postoperatively but the patient converted to normal sinus rhythm spontaneously during follow-up.


   Introduction
TOP
 Abstract
 Introduction
Case Report
 Discussion
 References
 
Most cardiac myxomas (75%) arise from the left atrium and approximately 17% are found in the right atrium but valvular myxomas are rare. 1 , 2 A case of mitral valve myxoma arising from the anterior leaflet is described.


   Case Report
TOP
 Abstract
 Introduction
 Case Report
Discussion
 References
 
A 19-year-old man was admitted with a history of palpitations and dyspnea on exertion. He had been in New York Heart Association functional class II to III for 6 months. There was no history of syncope, transient ischemic attack, thromboembolic episode, chest pain, or rheumatic fever. Two of his older brothers had died at 26 and 27 years due to some form of cardiac disease. On physical examination, his pulse rate was 104 beats•min –1 and regular, with all peripheral pulses palpable. Blood pressure was 116/72 mm Hg. The first heart sound was soft and there were systolic and grade III to IV diastolic murmurs on the left sternal border at the 3rd and 4th intercostal spaces. No opening snap or tumor plop was detected. Electrocardiography showed a regular heart rate of 104 beats•min –1 with no ventricular hypertrophy. Chest radiography revealed a cardiothoracic ratio < 50% with bilateral increased pulmonary vascular markings and enlargement of the left atrium. On echocardiography, a 3.2 x 3 cm left ventricular mass was seen arising from the anterior leaflet of the mitral valve. There was moderate mitral regurgitation, the left atrium was 42.5 mm in diameter, the internal dimensions of the left ventricle were 54.4 mm in diastole and 32.4 mm in systole, and the ejection fraction was 65.4% ( Figure 1 Go ).



View larger version (147K):
[in this window]
[in a new window]
  		Figure 1. Echocardiographic appearance of myxoma of the anterior mitral leaflet. AO = aorto, LA = left atrium, LV = left ventricle, M = myxoma, MV = mitral valve, RV = right ventricle.

 
Surgery was performed under full cardiopulmonary bypass through a median sternotomy. A superior septal approach was used with the incision extending from the right atrium into the interatrial septum and the roof of the left atrium. On examination of the mitral valve, a sessile tumor was seen arising from the anterior leaflet, involving the posteromedial commissure, part of the posterior leaflet, and the chordae. It was not possible to save the mitral valve so it was replaced with a 2M Starr-Edwards mechanical prosthesis (Baxter-Edwards, Horw, Switzerland) using interrupted pledgeted sutures. The left ventricular cavity was inspected and washed thoroughly before replacing the valve, the right ventricle was inspected through the right atrium; no other myxomatous lesion was seen. The patient came off bypass with a temporary pacemaker because he had developed heart block. He was ventilated overnight. On the 2nd postoperative day, he developed atrioventricular block (junctional type) with a ventricular rate of 48 beats•min –1 and normal QRS complexes. Temporary pacing was gradually switched off and the pacemaker was disconnected on the 5th postoperative day. The patient was discharged on the 9th postoperative day with a ventricular rate of 48 beats•min –1 . He was able to perform routine activities normally. The tumor with the mitral leaflet was 3.5 x 3.5 x 1 cm in size. The tissue was composed mainly of myxoid stroma with stellate myxoid cells and fibroblasts. Small areas of calcification were seen throughout the tumor tissue. Sections taken from the attached valvular leaflet showed dense fibrocollagenous valvular tissue in continuation with myxoid tissue of the tumor.

At follow-up 10 months postoperatively, electrocardio-graphy showed a heart rate of 65 beats•min –1 with normal sinus rhythm and an adequate response to exercise.


   Discussion
TOP
 Abstract
 Introduction
 Case Report
 Discussion
References
 
Most left atrial myxomas arise from remnants of myxoid tissue of embryonic myocardium. These remnants are present in the region of the fossa ovalis, accounting for the occurrence of most atrial myxomas at this site. Surgical resection is mandatory but there has been disagreement on the extent of resection. Simple excision of the tumor was considered adequate by Attar and colleagues 3 in 1980, although recurrent left atrial myxoma had been reported by Gerbode and colleagues 4 in 1967. Since then, there have been many more reports of tumor recurrence. 2 Kabbani and Cooley 5 favored a radical approach to prevent local implantation and systemic embolization. For this reason, part of the annulus was excised up to the posteromedial commissure in this patient. As he could perform routine activities, a permanent pacemaker was not implanted; normal sinus rhythm was restored sponta-neously. The patient is under close follow-up to check for recurrence of myxoma or development of further rhythm disturbance.


   Acknowledgments
 
I am thankful to Prof. Asha Agarwal, Department of Pathology, G.S.V.M. Medical College, Kanpur, for her contribution in establishing the accurate diagnosis of this case. I am also thankful to Raj Kumar (Personal Assistant) for his interest and clerical assistance.


   References
TOP
 Abstract
 Introduction
 Case Report
 Discussion
 References
 

  1. Sandrasagra A, Oliver WA, English TAH. Myxoma of the mitral valve. Br Heart J 1979; 42 :221 –3.[Abstract/Free Full Text]

  2. Read RC, White HJ, Murphy ML, Williams D, Sun CN, Flanagan WH. The malignant potentiality of left atrial myxoma. J Thorac Cardiovasc Surg 1974; 68 :857 –68.[Medline]

  3. Attar S, Lee YC, Singleton R, Scherlis L, David R, McLaughlin JS. Cardiac myxoma. Ann Thorac Surg 1980; 29 :397 –405.[Abstract]

  4. Gerbode F, Kerth WJ, Hill JD. Surgical management of tumors of the heart. Surgery 1967; 61 :94 –101.[Medline]

  5. Kabbani SS, Cooley DA. Atrial myxoma: surgical con-siderations. J Thorac Cardiovasc Surg 1973;65:731–7.[Medline]





This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Vinay Krishna
Pramod Sharma
Pankaj Srivastava
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dayal, A.
Right arrow Articles by Srivastava, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Dayal, A.
Right arrow Articles by Srivastava, P.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS