Ventricular Myxoma Research Articles

Left ventricular myxoma originating from the interventricular septum and obstructing the left ventricular outflow tract

In a 60-year-old woman with episodic exertional faintness, a large left ventricular (LV) myxoma attached by a pedicle to the apical interventricular septum and prolapsing through the LV outflow tract and the aortic valve causing a severe obstruction was found by echocardiography. Early surgical excision was successfully performed using the transaortic approach.

Diagnosis of left ventricular myxoma with cardiac magnetic resonance imaging

Ingrid Bar, MD Institut fur diagnostische und interventionelle Radiologie Klinikum Nurnberg-Sud 90471 Nurnberg, Germany Sirs: A 20-year-old man presented with palpitation without typical angina, dyspnoe, syncope and vertigo. There was no medical history and no family member had a history of syncope. ECG showed sinus rhythm, normal heart rate, normal PR interval and QRS duration, no ST-segment elevation or negative T-waves. 24-h ECG showed no pathological findings. All laboratory parameters including cardiac biomarkers were normal. Echocardiography (TTE) revealed a 21×26 mm large intracardiac tumor localized in the left ventricle (LV) attached to the anterior wall. LV diameter and function were normal. For further characterization of tumor pathology, a cardiac magnetic resonance (CMR) study was performed. Cine-CMR showed a normal size and function of the LV (EDD 153 ml, EDS 64 ml, LV-EF 59%, LV-cardiac output 4.9 l/min). CMR confirmed the echocardiographic findings: the tumor size was measured as 19×26 mm. The tumor was clearly attached to the anterior endocardium (segment 7) by a nar-

A Case of Carney Complex: Diagnosed 11 Years after Resection of Recurrent Cardiac Myxomas

Carney complex (CNC) is a rare disease characterized by myxoma, spotty skin pigmentation, and multiple neuroendo crine tumors. Here, we present a case of CNC, diagnosed 11 years after resection of recurrent cardiac myxomas. We had previously reported a 37-year-old woman in 1984 as biatrial myxomas and in 1994 as recurrent left atrial and ventricular myxomas, and at those times, she did not have any other myxomas and skin lesions. On her present admission, she had skin pigmentation and myxomatosis of breast, nostril and forearm. Upon the examination of her relatives, no characteristics of CNC were found on them. She was diagnosed as a sporadic form of CNC. If cardiac myxomas tend to be multiple and recurrent, we should consider the possibility of CNC, even other characteristics of CNC except cardiac myxomas are not present at diagnosis. (Korean Circulation J 2007;37:183-186)

Left ventricular outflow tract myxoma accompanied by dextrocardia with situs inversus: a case report

Myxoma is the most frequently encountered primary tumour of the heart, comprising more than 50% of all benign cardiac tumours. The case presented here was diagnosed as having dextrocardia with situs inversus and concomitant left ventricular outflow tract myxoma which has been very rarely encountered, particularly consistent with the scarcity of reported cases.

Right Ventricular Myxoma with Partial Right Ventricular Outflow Tract Obstruction

Right Ventricular Myxoma with Partial Right Ventricular Outflow Tract Obstruction

Multicentric Cardiac Myxoma Treated with Extended Surgery

We present the case of a 37-year-old male patient with a multicentric myxoma admitted to hospital with dyspnoea, syncope and chest pain. Physical examination revealed a grade 3/6 systolic murmur at the left lower sternal border and diffuse bilateral lung rales. Transthoracic echocardiography and thoraco-abdominal computed tomography revealed a right atrial mass and a right ventricular mass obstructing the outflow tract. The patient underwent urgent surgical treatment. At operation, a solitary right atrial myxoma and a right ventricular myxoma originating from the tricuspid valve and attached to the free wall of the right ventricle were seen. The tumours were successfully excised and the tricuspid valve was replaced with a No. 33 Omnicarbon metallic valve. The right ventricular free wall was repaired with a glutaraldehyde-treated pericardial patch. Histopathological examination of the tumours confirmed the diagnosis of myxoma. Post-operative recovery was uneventful and there was no recurrence after 1 year's follow-up.

IMAGE SECTION Section Editor: Ivan D'Cruz, M.D.: Asymptomatic Left Ventricular Myxoma Diagnosed Incidentally by Transthoracic Echocardiography

IMAGE SECTION Section Editor: Ivan D'Cruz, M.D.: Asymptomatic Left Ventricular Myxoma Diagnosed Incidentally by Transthoracic Echocardiography

Left ventricular thrombus sans overt cardiac pathology

A 25-year-old man presenting with peripheral and cerebral emboli was incidentally detected as having a left ventricular mass on two-dimensional echocardiographic examination of the heart. In absence of any obvious structural heart disease or hypercoagulable state, the mass was presumptively diagnosed as left ventricular myxoma. The patient was operated on, and histopathology revealed the mass to be a thrombus. The cause and pathogenesis of the left ventricular thrombus, differential diagnosis, and management are discussed. The rarity of the case is highlighted.

Right Ventricular Myxoma Prolapsing into Pulmonary Artery with Significant Obstruction

Right Ventricular Myxoma Prolapsing into Pulmonary Artery with Significant Obstruction

Left Ventricular Myxoma Associated Acute Pulmonary Embolism

Left Ventricular Myxoma Associated Acute Pulmonary Embolism

Management of Cardiopulmonary Bypass during Minimally Invasive Cardiac Surgery

From December 1996 to December 1997, 58 patients underwent minimally invasive cardiac surgery in our institute. The operations comprised 10 for atrial septal defect, 26 for ventricular septal defect, 15 for mitral stenosis and insufficiency, 4 for aortic valve insufficiency, 2 for left atrial myxoma, and 1 for right ventricular myxoma. There were 21 men and 37 women with a mean age of 20 years (range, 5 to 46 years) and a mean weight of 35 kg (range, 15 to 68 kg). To establish cardiopulmonary bypass, femorofemoral and superior vena caval cannulation or femoral artery and two-stage cannulation was used. Normothermia with a beating heart or moderate hypothermia with aortic cross-clamping during cardiopulmonary bypass were employed. All patients resumed sinus rhythm spontaneously, except for one who was easily defibrillated. There were no deaths or neurologic complications and no problems with the cannulation sites. We concluded that these techniques of cardiopulmonary bypass were feasible and safe.

Mobilization of the anterior mitral leaflet for excision of a left ventricular myxoma

Left ventricular myxomas are extremely rare. We report use of a left atrial approach with mobilization of the anterior mitral valve leaflet to enhance exposure of the subvalvar region and facilitate excision of a left ventricular myxoma entangled within the chordal apparatus, lying between the anterolateral papillary muscle and the left ventricular wall. The detached mitral leaflet was reattached to the annulus with a continuous suture. The tumor was completely excised, thus avoiding a separate transventricular or transaortic approach.

A Case of Left Ventricular Myxoma with Unusual Echocardiographic Findings

A Case of Left Ventricular Myxoma with Unusual Echocardiographic Findings

Extracardiac myxoma: An unusual right ventricular epicardial location

(J Thorac Cardiovasc Surg 1997;114:672-4)

SURGICAL TREATMENT FOR CARDIAC MYXOMAS-A REVIEW OF 13 CASES-

Thirteen patients with primary cardiac myxoma surgically treated in our hospital between October 1976 and November 1994 were a assessed in regard to the long-term outcome of surgical management. There were seven men and six women, 15 to 73 years old at the time of surgery (average age: 50). In addition to cardiac myxoma, preoperatively five patients had heart failure, two cerebral embolism, and one cardiac arrest, and 11 of the 13 patients had leukocytosis or high C-reactive protein (CRP) levels. The tumor arose in the left atrium in 12 patients and in the right ventricle in one patient. The left atrial myxomas were exposed by transseptal atriotomy in seven patients, transverse biatriotomy (Dubost incision) in three and bilateral longitudinal atriotomy and left atriotomy from the right side in one patient each. The right ventricular myxoma was excised by right atriotomy. Supraventricular arrhythmia occurred in six patients (46%), cerebral embolism in two, and respiratory failure, acute renal failure, low-output syndrome (LOS), and heart failure in one patient each in the early postoperative period. There was one surgical death caused by LOS secondary to preoperative cardiac arrest and one hospital death due to heart failure secondary to residual mitral regurgitation after mitral annuloplasty. One patient died of a cerebrovscular accident in the late period possibly secondary to recurrent myxoma. We emphasize the necessity of strict postoperative follow-up for probable tumor recurreuce and secondary cerebral infarction.

Video-assisted cardioscopic resection of recurrent left ventricular myxoma

Cardiac myxoma most often arises from the left atrium, where 80% to 90% of cardiac myxomas are located. Ventricular myxomas comprise fewer than 5% of all cardiac myxomas. Those located in the left ventricle are extremely rare. Traditionally, removal of a left ventricular myxoma is done through aortotomy if the myxoma is located at the left ventricular outflow tract and through the atrium for other locations. We report a case of recurrent deep-seated left ventricular myxoma removed through an aortotomy with video-assisted cardioscopy. Case report. A 20-year-old woman had a first episode of near-syncope 3 years before the operation under discussion was done. Transient bilateral visual loss, general weakness, palpitation, and cold sweating were noted. She had full recovery from the symptoms after squatting for 10 minutes. Since then, she had exercise intolerance and exertional chest pain. Episodes of transient visual loss occurred frequently. One year after the first episode she had a grade 4 systolic ejection murmur over the left upper sternal border with radiation to the aortic area. A midsystolic plop was audible over the cardiac apical area. A thrill was palpable with some heartbeats in the aortic area. No signs of congestive heart failure were noted. Echocardiography showed a 6 × 5 cm 2 tumor originating from the interventricular septum near the posterior papillary muscle. The tumor compressed the left ventricular outflow tract during systole and caused mild mitral prolapse. Cardiac catheterization confirmed the presence of the tumor at the inflow tract of the left ventricle. An emergency operation had been undertaken at that time. With the use of cardiopulmonary bypass and cardioplegic protection, the left atrium was approached through an interatrial incision. Because of poor visualization of the tumor through the mitral valve, the anterior mitral leaflet was detached. A 6 × 5 × 5 cm 3 multilobulated grayish-brown tumor was found in the left ventricle with a stalk from the interventricular septum. The entire tumor was removed piece by piece. However, the underlying endocardium was not resected. On pathologic examination the tumor was composed of round, polygonal, or stellate cells surrounded by abundant eosinophilic myxoid substance, which is typical of a cardiac myxoma. She had an uneventful postoperative course and no residual tumor was found by echocardiography. She was regularly followed up in the outpatient clinic. No discomfort was noted after the operation. However, a 2.1 × 1.9 cm 2 tumor with a stalk attached to the interventricular septum was demonstrated by echocardiography 2 years after the first operation. The tumor was thought to be a recurrent left ventricular myxoma. A repeat operation was done. Using cardiopulmonary bypass, a transverse aortotomy was done. The cardioscope was inserted and a multilobulated jellylike tumor at the base of the anterior septum near the posterior papillary muscle was noted (Fig. 1). The tumor with a piece of myocardium beneath it was removed piece by piece under video-assisted cardioscopic visualization. The tumor was gelatinous, transparent, and soft. Microscopically, it was shown to be a myxoma composed of stellate cells in myxoid stroma. The patient had an uneventful recovery after the second operation. Discussion. Left ventricular myxomas are extremely rare. Only 16 cases had been reported in the English literature up to 1993.1 The duration of clinical symptoms caused by left ventricular myxoma was no longer than 4 years. 2 It was suggested that the growth rate of the tumor was different from that of myxomas at other locations. However, clinical symptoms were not a reliable indicator because they were related to several additional factors, including the precise location of the tumor. Recurrence of myxomas at other locations was reported to occur 17 years on the average after initial presentation. 1 This case is the first reported of a recurrent isolated left ventricular

Surgical treatment of right ventricular myxoma in infancy

Myxomas are the most common of all primary cardiac tumors in adults. They are extremely rare in infancy. We report on a 5-month-old infant who was admitted in a state of cardiogenic shock. Echocardiography showed a right ventricular myxoma completely occluding the right ventricular outflow tract. prompt surgical removal of the tumor resulted in a excellent outcome.

Transaortic and transatrial excision of left ventricular myxoma in a child

We report an unusual case of myxoma arising from the left ventricular papillary muscle and interventricular septum in an 11-year-old child. It was diagnosed by echocardiography. The tumour was removed through transaortic and transatrial routes under cardiopulmonary bypass.

Recurred Left Atrial and Left Ventricular Myxoma after Surgical Excision of Biatrial Atrial Myxoma

Recurred Left Atrial and Left Ventricular Myxoma after Surgical Excision of Biatrial Atrial Myxoma

Recurred Left Atrial and Left Ventricular Myxoma after Surgical Excision of Biatrial Atrial Myxoma

Recurred Left Atrial and Left Ventricular Myxoma after Surgical Excision of Biatrial Atrial Myxoma