EComment. Isolated valvular myxoma

Abstract

We read with great interest the report by Fernandez et al [1]. They presented a case of a 28-year old male patient with a sessile myxomatous tumour localized on the ventricle aspect of the right and left cusps of the aortic valve. Valve-sparing aortic root reconstruction was impossible, therefore a mechanical aortic valve was implanted. Myxomas are the most common primary cardiac tumours, typically located in the left atrium at the level of the fossa ovalis (three-quarters of these tumours) [2]. Valvular myxomas are extremely rare, atrio-ventricular valves being more involved than the aortic or pulmonary valves. The mitral valve is the most frequently affected structure, followed by the tricuspid, the aortic, and the pulmonary valves [3]. This case provides the possibility to discuss the clinical and pathologic features of valvular myxomas. Myxomas of the aortic valve are usually located at the ventricle side, involving one or two aortic cusps. The mean age at diagnosis is 44 (range 15-72). Ten cases of aortic valve myxomas have been published in the English literature [1, 4, 5], and they all showed a unique feature, that is, an isolated myxoma on the aortic valve. None of these patients presented with Carney's complex, therefore we can conclude that, to date, familial myxomas do not involve aortic valves. Recently, an additional case report was published on the same subject [4]. A 10x8-mm myxoma attached to the non-coronary cusp of the aortic valve from the ventricle side was incidentally found during an echocardiogram. The 72-year old man was operated under cardiopulmonary bypass, the tumour was resected, and the aortic valve was successfully repaired. The postoperative course was uneventful. This is the oldest patient operated on with an aortic valve myxoma. We completely concur with the statement that the main differential diagnosis is made with papillary fibroelastoma, which is generally described as arising from the ventricle aspect of the aortic valve, that a surgical approach should be considered in all these patients, and that echocardiogram follow-up must be recommended [5]. Conflict of interest: none declared.