Myxoma involving the atrial valve chordae

Primary cardiac valve tumors are rare and comprise less than 10% of all cardiac tumors. They are, however, of clinical importance because of their unique locations. We report an unusual case of myxoma involving the tricuspid valve chordae in a young woman presenting with syncope. The myxoma was diagnosed by echocardiography and successfully removed by excision of the involved tricuspid valve chordae with valve preservation. (Curr Surg 57:357-358)     

Tumor‐like tricuspid myxomatus degeneration with a primary cardiac leiomyoma: A rare case report

We present an unusual case of a 47‐year‐old male with a cardiac mass arising from the tricuspid valve, which was misdiagnosed as a cystic myxoma. The patient received successful resection of the pathological tissue and tricuspid valvuloplasty. The mass turned out to be tricuspid cystic myxomatus degeneration with a primary cardiac leiomyoma finally. There was no recurrence after complete resection and tricuspid valvuloplasty by 1‐year follow‐up. To our best of our knowledge, only several cases of primary cardiac leiomyoma have been reported, and this is the first case of primary cardiac leiomyoma involving the tricuspid valve in an adult man. The present case suggests that the tricuspid valve should be another rare site of primary cardiac leiomyoma.     

Myxoma of the tricuspid valve.

Myxomas of the intraventricular cavity are extremely rare, and those of right ventricular origin are the least frequent. Only three cases of myxoma of the tricuspid valve have so far been reported. In this communication a myxoma of the tricuspid valve in a 23-year-old woman is reported because of its unusual and interesting clinical presentation and the extreme rarity of this lesion.     

Right ventricular myxoma: Report of a case

We herein report a 36-year-old man who underwent surgical resection for myxoma. Preoperative two-dimensional echocardiography demonstrated a mass in the right ventricle. Intraoperatively, the tumor was found to derive from an anterior papillary muscle of the tricuspid valve. The tumor was successfully excised and the tricuspid valve was repaired with chordoplasty and annuloplasty. A histopathological examination revealed myxoma and a 2-year follow-up has shown no evidence of recurrence or tricuspid valve regurgitation.     

Tricuspid Valve Myxoma: A Case Report and a Collective Review of the Literature

Abstract   Tricuspid valve myxoma is extremely rare. An asymptomatic young patient discovered by chance an echogenic mass on the tricuspid valve by echocardiography, which was proved to be a myxoma. He underwent a successful myxoma resection via port-access approach. He had an uneventful postoperative course. Port-access approach is an alternative to conventional open heart surgical technique in terms of its minimally invasive purpose for myxoma resection. Moreover, it is of great importance in reducing the risk of intraoperative embolization and tumor implantation by minimizing the heart maneuver.     

Unusually large left atrial myxoma causing mitral valve occlusion and hiding a severe mitral regurgitation: a case report

We report a case of a 68-year-old woman with a large left atrial myxoma occluding the mitral valve. The tumor was diagnosed by preoperative echocardiogram. During the operation and after the myxoma resection, a severe mitral valve regurgitation, which was not observed during the preoperative echocardiogram, was noticed. Mitral valve defect was corrected by an annuloplasty ring, and the patient had an uneventful recovery. Careful evaluation of the mitral valve during a myxoma resection operation is recommended.     

Tricuspid valve myxoma in a pediatric patient: 10-year follow-up after resection

Cardiac myxomas are rarely encountered in pediatric patients. Tricuspid valve involvement in these cases is even more exceptional. We report the case of a 5-year-old girl operated on successfully 10 years ago for a tricuspid valve myxoma who continues to be asymptomatic and had an event free outcome.     

Tricuspid valve repair for tricuspid valve endocarditis: tricuspid valve "recycling"

Tricuspid valve endocarditis traditionally has been treated with either valve excision or valve replacement. To avoid implantation of foreign material in an infected field, we have applied the principles of mitral valve repair to 4 patients with tricuspid valve endocarditis. On preoperative echocardiography, all patients had 3 to 4+ tricuspid regurgitation, evidence of progressive right ventricular enlargement, and mobile vegetations. In each case, up to three quarters of the anterior leaflet was excised en bloc with infected chordae and papillary muscle heads. Surgical procedures included standard quadrangular resection, conversion to a bicuspid valve, and pericardial patch replacement of the anterior leaflet with mobilization of basal chordae to replace resected marginal chordae. On postoperative echocardiography, tricuspid regurgitation and right ventricular dimensions were reduced in 2 of 4 patients in spite of loss of leaflet tissue. All excised valve tissue demonstrated bacteria on Gram stain or culture. Nonetheless, all repaired valves were successfully sterilized without recurrent infections. Tricuspid valve repair can allow eradication of infection with potential for improving valve competency in complicated tricuspid valve endocarditis.     

Left ventricular outflow tract obstruction due to valve myxoma

A life-threatening left ventricular outflow tract obstruction developed in a 26-year-old man because of a very uncommon myxoma emerging from the ventricular side of the mitral valve. Immediate surgical treatment was indicated because of high-risk factors reported herein. After transaortic resection of a single myxoma, the progress of this patient has been excellent, especially as a familial myxoma could be excluded.     

Mitral valve recurrence of a left atrial myxoma.

Recurrence of intracardiac myxoma is unusual, and heart valves are extremely rare locations for this tumor to originate, either as the primary site or the site of recurrence. We present a case of non-familial cardiac myxoma, which after successful resection of the tumor mass from the left atrium, recurred in the atrial surface of anterior leaflet of the mitral valve, along with a review of similar cases in the literature. Myxoma was originally believed to recur due to inadequate resection, but recent data suggest the multicentric disease to be the reason. Mitral valve myxoma mainly presents with symptoms of embolization and appears to affect women more often. It involves both leaflets with the same frequency and usually originates from the atrial side. Transesophageal echocardiography is the gold standard for non-invasive diagnosis and localization. Operative resection of the tumor along with the underlying tissue followed by suture repair of the valve and annuloplasty is recommended as the most appropriate treatment option. Long-term follow-up of patients by echocardiography is advised for early detection of any recurrence.     

MYXOMA OF THE TRICUSPID VALVE

Myxomas of the intraventricular cavity are extremely rare, and those of right ventricular origin are the least frequent. Only three cases of myxoma of the tricuspid valve have so far been reported. In this communication a myxoma of the tricuspid valve in a 23-year-old woman is reported because of its unusual and interesting clinical presentation and the extreme rarity of this lesion.     

A case of tricuspid valvular myxoma in a child]

A six-year old boy had hospitalization because of cardiac murmur and syncope attack. Laboratory data including immunoglobulin and erythrocyte sedimentation rate were normal, but echocardiography and cardioangiography indicated tricuspid valvular myxoma in the right atrium. The tumor was successfully removed with the septal tricuspid valve using the cardiopulmonary bypass. The tumor was 18 x 20 x 12 mm in size and pathological findings showed a myxoma originated from tricuspid valve. Now he shows normal cardiac function and no recurrent sign of tumor. There has been reported a few cases of valvular myxoma in Japan. However, this is the first case which was successfully resected by surgery.     

Tricuspid valve plasty associated with removal of an infected pacemaker lead: report of a case

We performed tricuspid valve plasty in a 72-year-old woman with pacemaker lead infection and septicemia. All the infected pacemaker system was removed under cardiopulmonary bypass. Because of advanced adhesion and infection, we needed partial resection and plasty of the tricuspid valve. Postoperative echocardiography revealed only mild tricuspid regurgitation and the recurrence of infection has been avoided. Our technique of valve plasty was useful in a patient with advanced infection of both pacemaker leads and tricuspid valve leaflets.     

Valvuloplasty for aortic valve regurgitation resulting from cusp prolapse

Three adults, 2 with tricuspid aortic valve and 1 with bicuspid valve, underwent valvuloplasty for aortic valve regurgitation resulting from cusp prolapse. Surgical procedures consisted of combined cusp plication by triangular cusp resection and subcommissural annuloplasty. Doppler echocardiography revealed trivial aortic valve regurgitation intraoperatively and less than I/IV at discharge in all cases. After mean follow-up of 15 months, 2 tricuspid aortic valve patients remain I/IV regurgitation and II/IV in the bicuspid patient. Although long-term results remain unclear, our results show that this procedure is feasible and beneficial in patients with aortic valve regurgitation due to cusp prolapse.     

Papillary fibroelastoma of the tricuspid valve

A 72-year-old male patient was admitted with chest oppression. Echocardiography disclosed a mobile tumor which was located on the atrial side of the tricuspid valve. Neither tricuspid obstruction nor regurgitation was observed. The mobility and the size, 20 mm in diameter, of the tumor indicated the need to perform surgical treatment. Through a right atriotomy, the tumor with multiple papillary fronds was found on the basal zone of the anterior leaflet. A resection of the tumor and tricuspid valvuloplasty with a partial annular reconstruction were performed. A pathological examination confirmed papillary fibroelastoma. He had an uneventful recovery, and postoperative echocardiography detected neither any residual tumor nor tricuspid regurgitation. In conclusion, it is reasonable to state that echocardiography is useful for detecting cardiac tumors, and a surgical resection is indicated for a mobile or large papillary fibroelastoma even when it is located on the right side of the heart.     

Role of the septal leaflet in tricuspid valve closure. Consideration for treatment of complete atrioventricular canal.

A septal leaflet of the tricuspid valve is thought to work differently from other anterior and posterior leaflets. We studied its role in valve closure in dogs by means of a dynamic area meter. During the control state, the tricuspid valve orifice area increased twice in diastole coincidentally with either atrial systole or rapid ventricular filling. We observed several findings after the septal leaflet resection: (1) two peak area patterns of the tricuspid valve orifice in diastole, (2) no elevation of right atrial pressure on ventricular systole (there was no V wave), (3) no tricuspid valve regurgitation on right ventriculography. These findings suggest that a complete valve closure occurred without the septal leaflet in regular sinus rhythm. An elevation of the right ventricular pressure produced by pulmonary artery stenosis without septal leaflet, however, easily caused tricuspid valve regurgitation in contrast to the same pressure of the right ventricle with the normal tricuspid valve. The right ventricular pacing caused severe valve regurgitation without the septal leaflet. Results indicate that in the repair of the complete atrioventricular canal defect and other tricuspid valve lesions, the septal leaflet of the tricuspid valve rarely requires attention. An atrioventricular block should be avoided, however, because electrical cardiac pacing on the right ventricle causes severe valve regurgitation without the septal leaflet.     

Surgical treatment of cardiac myxomas

Information of 40 patients operated on for cardiac myxoma was reviewed. The age ranges were as follows: nine patients, 20 to 30 years; seven patients, 31 to 40 years; 10 patients, 41 to 50 years; and 11 patients, over 50 years. One patient each was 14 months, 14 years, and 16 years old. Left atrial myxoma was diagnosed in 31 patients, left ventricular myxoma in one, right atrial myxoma in five, and right ventricular myxoma in two. Multiple calcified right atrial and ventricular myxomas were detected in one patient. Detailed clinical characteristics and diagnostic methods are presented. The hospital mortality rate was 7.5%. At 15 years' follow-up practically all of the patients had good late results. There were no recurrent myxomas. Rare left ventricular myxomas and multiple calcified right atrial and ventricular myxomas involving a tricuspid valve are also presented.     

A new reconstructive operation for Ebstein's anomaly of the tricuspid valve

Ebstein's anomaly is a complex malformation involving the tricuspid valve and the right ventricle. Various surgical techniques, either repair or replacement of the abnormal tricuspid valve, have been used with variable results. In an attempt to enlarge the indications of conservative procedures, we developed a technique of repair that comprises the reconstruction of a normally shaped right ventricle and the repositioning of the tricuspid valve at the normal level. In a series of 14 patients operated on between January 1980 and December 1986 in our institution, only one patient with an associated atrioventricular septal defect required a tricuspid valve replacement. All of the other patients, regardless of the complexity of the tricuspid malformation, were able to benefit from this conservative technique. There were two hospital deaths and no late deaths in this series. All surviving patients displayed a marked improvement over their preoperative status with regard to functional class (92% are in class I or II) and rhythm disturbances. Echocardiographic and Doppler studies demonstrated a normal shape of the right ventricle and good tricuspid valve function in all the patients but one.     

Tricuspid valve obstruction caused by plasmacytoma metastasis.

A patient undergoing resection of a solid, right-sided intracardiac plasmacytoma metastasis causing severe dyspnea and tricuspid valve obstruction is reported. A review of the literature verified the rarity of this clinical finding.     

三尖瓣替换术及早期结果

目的 探讨三尖瓣替换术（TVR）的手术适应证和人工瓣膜的选择。方法 1997年3月至2004年6月,共施行TVR42例,其中20例有心脏手术史。手术适应证：①自然瓣膜损毁无法修复（34例）;②进行性三尖瓣病变（2例）;③修复后残余的瓣膜功能不全仍严重影响心脏功能（6例）。合并下列情况时,积极选择TVR：肺血管阻力中、重度升高;手术后有残余的左心功能不全;有三尖瓣成形手术史。人工心脏瓣膜替换术包括：单纯TVR30例,主动脉瓣和二尖瓣加TVR8例,二尖瓣加TVR3例,主动脉瓣加TVR1例。三尖瓣位人工瓣使用双叶型机械瓣28枚,生物瓣14枚。其他合并的心脏手术包括：先天性心脏畸形修复10例,人工瓣周漏修补、黏液瘤切除、冠状动脉搭桥各1例。结果 全组手术病死率17％（7／42）,手术并发症发生率31％（13／42）。术后心功能（NYHA分级）：Ⅰ级21例,Ⅱ级10例,Ⅲ、Ⅳ级各1例。术后晚期死亡2例。结论 当三尖瓣的病变程度严重,修复把握不大,特别是伴有肺血管病变、左心功能不良、左心病变未能完全矫治时,应积极行TVR;人工瓣应选择双叶型和机械瓣或生物瓣,特别是后者。