Cardiac myxoma originating from mitral valve leaflet

Abstract

Primary heart tumors are an extremely rare disease, with a prevalence of 0.0017%0.03% in the population according to various data.
 Heart tumors are benign in most cases, and more than half of such formations are represented by cardiac myxomas. Myxoma is the most common primary cardiac tumor; however, its number is extremely small among the general population. Myxoma that affects the cardiac valves is a rare pathology. For the first time, such variance of changes was described in 1934. Most often, cardiac myxomas are localized at the atrial septum level near the oval fossa. One of the typical signs of myxoma is a narrow leg and an uneven surface, which causes the risk of embolism. Echocardiographic examination and magnetic resonance imaging are currently the methods of choice when suspecting the presence of volumetric heart formation. With such atypical tumor localization, conducting a mandatory differential diagnosis with heart valve vegetations and papillary fibroelastoma is necessary.
 Herein, presented an elderly patient with complaints of shortness of breath, stabbing pains in the left half of the chest, and arrhythmias with a history of aspiration pneumonia and esophageal extirpation with stomach esophagogastroplasty. During the examination, the patient revealed a paroxysmal form of atrial fibrillation (outside of paroxysm), chronic heart failure, and arterial hypertension. The clinical data of the patient were not characteristic enough for the possibility of infectious endocarditis with valvular vegetations. The echocardiographic examination and multispiral computed tomography with bolus contrast enhancement on the atrial surface of the posterior flap of the mitral valve revealed an additional volume formation of 59 mm in size, rounded shape, with clear uneven contours, together with the valve flap into the left ventricular cavity into the atrial systole. The formation was optimally visualized using the Fiesta-CINE mode in modified two- and four-chamber projections. The formation was removed with suture plasty of the mitral valve in artificial blood circulation conditions. The histological examination of the formation revealed a morphological characteristic of myxoma. The postoperative period proceeded without complications.