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Ann Thorac Surg 2009;88:1022. doi:10.1016/j.athoracsur.2008.12.051
© 2009 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Unusual Complication of Aortic Valve Grape-Like Myxoma

Wojciech Dyk, MD, PhDa,*, Marek Konka, MD, PhDb

a First Department of Cardiac Surgery, National Institute of Cardiology, Warsaw, Poland
b Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland

* Address correspondence to Dr Dyk, First Department of Cardiac Surgery, National Institute of Cardiology, Alpejska Str 42, Warsaw, 04-628, Poland (Email: wojdyk{at}ikard.pl).

A 15-year-old boy was transferred to our hospital because of an acute myocardial infarction and persistent chest pain. His electrocardiogram showed an inferior and anterolateral infarct with persistent ST elevation and Q-wave. Elevations were documented in the levels of troponin I (25.59 ng/mL), creatine phosphokinase (3014 U/L), and creatine kinase-MB subunit (250.6 U/L).

Coronary angiography performed shortly after admission revealed an occlusion of the left anterior descending artery in the middle segment. Percutaneous transluminal coronary angioplasty of the occluded artery was unsuccessful, but the chest pain stopped after this procedure. Transthoracic and transesophageal echocardiography showed aortic valve myxoma and akinesis of the left ventricular anterior wall (Fig 1, arrow).


Figure 1
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  		Fig 1.
 
The operation was postponed for 7 days due to the acute myocardial infarction and the persistent elevated biochemical markers. During the operation the 4.0- x 1.0-cm aortic valve myxoma connected to the margin of noncoronary cusp was excised with a 1-mm free margin of noncoronary cusp (Fig 2). Postoperative a transesophageal echocardiography showed only a small aortic regurgitation.


Figure 2
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  		Fig 2.
 
The patient's postoperative course was uneventful, and he was discharged in good clinical condition 10 days after operation.

Histologic examination confirmed the diagnosis of myxoma (Fig 3).


Figure 3
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  		Fig 3.
 





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