Ann Thorac Surg 1997;63:234-236
© 1997 The Society of Thoracic Surgeons
Case Report
Myxoma of the Aortic Valve
Shoji Watarida, MD,
Kazuhiko Katsuyama, MD,
Ryuzaburo Yasuda, MD,
Tatsuo Magara, MD,
Masahiko Onoe, MD,
Takehisa Nojima, MD,
Takaaki Sugita, MD
Second Department of Surgery, Shiga University of Medical Science, and Department of Cardiovascular Surgery, Shiga Seijinbyou Medical Center, Shiga, Japan
Accepted for publication July 26, 1996.
 |
Abstract
|
|---|
Myxoma of the aortic valve is exceedingly uncommon. In this article, we report a 58-year-old man with myxoma arising from the aortic valve. Aortic valve replacement was performed, and postoperative histologic examination showed myxoma of aortic valve.
|
Introduction
|
|---|
Myxomas are one of the most common cardiac tumors but are usually confined to the atria. Myxomas of the heart valves are relatively rare cardiac tumors. We describe a patient with myxoma of the aortic valve successfully treated by surgical excision.
A 58-year-old man with hypertension was hospitalized for examination of cardiac function. No history suggestive of previous bacterial endocarditis was recognized. His pulse was 75 beats/min and regular. Blood pressure was 178/102 mm Hg. On auscultation of the heart, a heart murmur was not heard. Electrocardiography showed signs of left ventricular hypertrophy. Chest x-ray examination revealed a large cardiac shadow. Two-dimen- sional echocardiography showed an 11 x 11-mm mass attached to the right coronary cusp of the aortic valve (Fig 1
). Aortography disclosed a filling defect on the right coronary cusp of the aortic valve (Fig 2). Preoperative coronary angiography showed normal findings.
View larger version (119K):
[in this window]
[in a new window]
|
Fig 2. . Aortic root cineangiogram in systole demonstrating that the mass (arrow) is mobile and related to the aortic cusp motion.
|
|
The patient underwent an open heart operation under cardiopulmonary bypass with moderate total body hypothermia. The aorta was cross-clamped and opened by oblique incision. Inspection of the aortic root revealed a normal structure, but tumors were found on the ventricular surfaces of the right coronary cusp of aortic valve. The tumor measured 1.1 x 1.0 cm and had a jelly-like hemispheric shape. The aortic valve with this tumor was excised and replaced with a 25-mm Björk-Shiley prosthesis. The postoperative convalescence was uncomplicated, and he was discharged from the hospital on the 25th postoperative day. No residual tumor was evident on the postoperative echocardiogram performed 3 years after the operation.
Histologically, the resected specimen was diagnosed as a primary cardiac tumor and classified as a myxoma (Figs 3, 4). The right coronary cusp of the aortic valve had a normal structure, and the tumor arose from the surface of the aortic valve. Histologic examination of the mass confirmed myxoma of the aortic valve.
View larger version (137K):
[in this window]
[in a new window]
|
Fig 4. . Histologic section through the tumor and aortic valve. (Hematoxylin and eosin; x50 before 51% reduction.)
|
|
|
Comment
|
|---|
Myxomas of the cardiac valves are rare; in particular, myxoma of the aortic valve is exceedingly uncommon [1]. Most valve tumors are asymptomatic [2, 3] and found incidentally at autopsy [4], but recently there has been an unequivocal increase in the premortem diagnosis of cardiac tumors, including valve tumors. This is most directly attributable to technologic advances and more frequent use of echocardiography. In our case, the patient had no symptoms and a tumor of the aortic valve was found incidentally on echocardiographic examination for cardiomegaly. Some authors have reported association of these tumors with anginal symptoms or even fatal coronary events [5, 6] and systemic embolization [7–9]. Long-term results from surgical treatment of cardiac myxomas are not completely understood due to its recurrence. The rate of recurrence is very low [10], except in cases involving young patients or recurrent, familial [11], multiple, or complex myxomas [10]. Some reports suggested that recurrence may be due to incomplete removal, but inadequate resection seems to be only one factor in recurrence [10–12].
|
Footnotes
|
|---|
Address reprint requests to Dr Watarida, Second Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa Otsu, Shiga, 520-21, Japan.
|
References
|
|---|
- Wold LE, Lie JT. Cardiac myxomas. Am J Pathol 1980;101:219–40.[Medline]
- Riecmann C, Liebau G, Hellberg K, Seelinger H. Papillary fibroelastoma of aortic valve: primary echocardiographic diagnosis in an asymptomatic case. Z Kardiol 1990;79:208–10.[Medline]
- Edwards FH, Hale D, Cohen AJ, Thompson L, Pezzella AT, Virmani R. Primary cardiac tumor. Ann Thorac Surg 1991;52:1127–31.
- Pomerance A. Papillary tumors of the heart valves. J Pathol Bacteriol 1961;81:135–40.
- Zull DN, Diamond M, Beringer D, et al. Angina and sudden death resulting from papillary fibroelastoma of the aortic valve. Ann Emerg Med 1985;14:470–3.[Medline]
- Etienne Y, Jobic Y, Houel JF, et al. Papillary fibroelastoma of the aortic valve with myocardial infarction: Echocardiographic diagnosis and surgical excision. Am Heart J 1994;127:443–5.[Medline]
- Kennedy P, Parry AJ, Parums D, Pillai R. Myxoma of the aortic valve. Ann Thorac Surg 1995;59:1221–3.[Abstract/Free Full Text]
- McFadden PM, Lacy JR. Intracardiac papillary fibroelastoma: an occult cause of embolic neurologic deficit. Ann Thorac Surg 1987;43:667–9.[Abstract/Free Full Text]
- Imamaki M, Nakajima M, Hirayama T, Hirota J, Hikawa H, Hagiwara S. A case report of surgical treatment for aortic valve papillary fibloelastoma. J Jpn Assoc Thorac Surg 1993;41:325–8.
- Castells E, Ferran V, Octavio-de-Toledo MC, et al. Cardiac myxomas: surgical treatment, long-term results and recurrence. J Cardiovasc Surg 1993;34:49–53.[Medline]
- McCarthy PM, Piehler JM, Schaff HV, et al. The significance of multiple recurrent and "complex" cardiac myxomas. J Thorac Cardiovasc Surg 1986;91:389–96.[Abstract]
- Sellke FW, Lemmer JH Jr, Vandenberg BF, Ehrenhaft JL. Surgical treatment of cardiac myxomas: long-term results. Ann Thorac Surg 1990;50:557–61.[Abstract/Free Full Text]
Top
Abstract
Introduction
