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Table of Contents
LETTER TO EDITOR  
Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 304-305
Anterior mitral leaflet myxoma: A rare occurrence


Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India

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Date of Web Publication1-Oct-2013
 

How to cite this article:
Wani M, Ahangar A, Singh S, Wani M, Ahangar A, Singh S. Anterior mitral leaflet myxoma: A rare occurrence. Ann Card Anaesth 2013;16:304-5

How to cite this URL:
Wani M, Ahangar A, Singh S, Wani M, Ahangar A, Singh S. Anterior mitral leaflet myxoma: A rare occurrence. Ann Card Anaesth [serial online] 2013 [cited 2019 Jul 21];16:304-5. Available from: http://www.annals.in/text.asp?2013/16/4/304/119192


The Editor,

Myxoma is the most common primary cardiac neoplasm and accounts for approximately one-half of all primary cardiac tumors. A left atrial myxoma was first described in a post-mortem examination in 1845. The specific signs and symptoms produced by a cardiac myxoma depend on its anatomic location. Approximately 75% of these tumors are found in left atrium and 18% in right atrium. The few remaining tumors originate from atypical sites such as left or right ventricle and valves. [1],[2],[3] Although, transesophageal echocardiography is more sensitive, two-dimensional (2D) transthoracic echocardiography (TTE) is usually adequate for diagnosis. Surgical resection of the myxoma is the treatment of choice, with low morbidity and mortality. We present a case of anterior mitral leaflet myxoma causing mild left ventricular outflow tract obstruction. A 60-year-old normotensive, non-diabetic woman with no past significant medical history presented to our emergency department with right sided weakness and aphasia since 2 days. Computed tomography brain showed an infarct in middle cerebral artery territory. Complete blood count, kidney function test, liver function test, and coagulogram were normal. X-ray chest showed cardiomegaly. 2D TTE showed a mass arising from anterior leaflet of mitral valve which was going into the left ventricle [Figure 1]. Mass was hyperechoic, mobile, well-defined with irregular margins measuring 1.6 × 3.2 cm. Gradient across left ventricular outflow tract (LVOT) was 35 mmHg. Diagnosis of an anterior mitral leaflet myxoma or healed vegetation due to previous endocarditis was considered.
Figure 1: Preoperative transthoracic echocardiography images showing mass arising from anterior mitral leaflet and projecting into left ventricular outflow tract

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Patient was taken for surgery under general anesthesia. Central venous and arterial lines were established. Patient was put on cardiopulmonary bypass and on arrested heart, left atrium was opened. Mass arising from anterior mitral leaflet going into the left ventricle was seen. Mass was excised along with the anterior mitral leaflet [Figure 2]. Mitral valve was replaced with a 25 size St. Jude mitral valve prosthesis. Patient was rewarmed and weaned off bypass. Patient was electively ventilated for 6 h and extubated and later shifted to ward, then discharged from the hospital and was put on oral anticoagulant. Histopathological examination of the mass was consistent with myxoma.
Figure 2: Myxoma attached to anterior mitral leaflet

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Most left atrial myxoma 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. Dominating symptoms and signs relate to tumor location, which seems to be the main factor predicting obstructive sequelae and influencing embolic sites. Left atrial myxomas commonly cause mitral valve obstruction mimicking symptoms of rheumatic heart disease, [4] while right-sided myxomas, being extremely rare, may present with nonspecific signs and symptoms, including right heart failure secondary to right ventricular outflow tract obstruction. [5] Mitral valve myxomas may be localized to the anterior mitral leaflet, posterior mitral leaflet or mitral annulus. Usually the tumor is localized to the atrial side of the mitral valve. [3] The treatment of choice for myxomas is surgical removal. Surgical resection is mandatory, but there has been disagreement on the extent of resection. Simple excision of the tumor is considered adequate by some, while others favor radical approach to prevent local implantation and embolization. We did a radical excision of the tumor along with the anterior leaflet of the mitral valve and part of annulus. The patient is under close follow-up to check for recurrence of myxoma.

 
   References Top

1.Mahdhaoui A, Bouraoui H, Amine MM, Mokni M, Besma T, Hajri SE, et al. The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis. Echocardiography 2004;21:333-6.  Back to cited text no. 1
[PUBMED]    
2.Sugeng L, Lang RM. Atypical cardiac myxomas. Echocardiography 2004;21:43-7.  Back to cited text no. 2
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3.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.  Back to cited text no. 3
[PUBMED]    
4.Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR. Cardiac myxoma: Imaging features in 83 patients. Radiographics 2002;22:673-89.  Back to cited text no. 4
[PUBMED]    
5.Mittle S, Makaryus AN, Boutis L, Hartman A, Rosman D, Kort S. Right-sided myxomas. J Am Soc Echocardiogr 2005;18:695.  Back to cited text no. 5
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Correspondence Address:
Mohd Lateef Wani
Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir
India
Mohd Lateef Wani
Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.119192

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