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 myxoma: a rare indication for tricuspid valve repair.

Excision of a myxoma involving the tricuspid valve often necessitates tricuspid valve replacement or a less than optimal margin of resection. We report a successful tricuspid valve repair after en bloc resection of a myxoma involving the septal leaflet of the tricuspid valve.     

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.     

Cardiac Sarcoma Originating from the Tricuspid Valve

Primary cardiac sarcomas are uncommon. We report an unusual presentation of a cardiac sarcoma that originated from the posterior leaflet of the tricuspid valve. This tumor, which provided a working diagnosis of tricuspid valve myxoma before and during surgery, should be considered in the differential diagnosis of right atrial and ventricular masses.     

Cardiac Myxoma

Ten patients with cardiac myxoma were reviewed. They ranged from 23 months to 60 years old. Echocardiography was the most helpful noninvasive diagnostic technique. The tumor was demonstrated by angiocardiography, left atrial myxomas frequently migrating to the left ventricle in diastole. Hemodynamically, left atrial myxomas were associated with moderately severe pulmonary hypertension and simulated mitral stenosis or insufficiency and right atrial myxomas, with right atrial hypertension. There were 7 myxomas in the left atrium, 2 in the right atrium, and 1 in the right ventricle.Eight patients underwent open-heart operation with removal of the myxoma, 1 had concomitant tricuspid valve replacement, and 1 had biopsy of the right ventricle only. The other patient was a Jehovah's Witness and refused operation. One patient died of cardiac arrest intraoperatively, and another died of a bilateral cerebral infarct. One patient had recurrence requiring reoperation. Postoperative hemodynamic and clinical improvement was more striking in patients with a left atrial myxoma presumably due to a normal mitral valve in contradistinction to the tricuspid valve.     

Bile Duct Injury during Laparoscopic Cholecystectomy: Risk Factors,Mechanisms, Type,Severity and Immediate Detection

34-year-old male with history of recurrent atrial fibrillation (AF) and mitral stenosis, status post radio-frequency ablation (RFA) and prosthetic mitral valve replacement two years earlier was admitted with prosthetic valve thrombosis for redo mitral valve surgery. During the surgery, a 2 χ 1.5 χ 1 cm mass was identified on the interatrial septum, attached to the edge of tricuspid valve’s septal leaflet by a stalk. The mass was excised and histological evaluation revealed myxoma. It is accepted that myxomas can develop after cardiac trauma. It is known that RFA for AF increases the risk of thrombus or endocarditis in the atrium. Herein, we report a myxoma case where we think the heat energy caused by RFA might have triggered the development of the tumor.     

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)     

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.     

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 in a 71-year-old female

Right ventricular myxoma in elderly is vey rare and this is the 36th case report of right ventricular myxoma in Japan. A healthy 71-year-old female with no symptoms or constitutional signs except heart murmur was hospitalized. Findings of transthoracic echocardiogram, CT scan, MRI and angiocardiogram demonstrated a mobile tumor in the right ventricular outflow tract. Transesophageal echocardiogram clearly revealed that the stalk was arising from the right ventricular free wall. Under cardiac arrest, right atriotomy was made and a gelatinous tumor (4.5 × 2 × 2 cm in size, 7.3 g in weight) was excised with 5 mm of surrounding endocardium and a few millimeters of underlying myocardium through the tricuspid valve. Histopathologically, the tumor was diagnosed as a myxoma. Her postoperative course was uneventful.     

Myxoma developing after open heart surgery: is radiofrequency ablation responsible for the formation of the tumor?

34-year-old male with history of recurrent atrial fibrillation (AF) and mitral stenosis, status post radiofrequency ablation (RFA) and prosthetic mitral valve replacement two years earlier was admitted with prosthetic valve thrombosis for redo mitral valve surgery. During the surgery, a 2 x 1.5 x 1 cm mass was identified on the interatrial septum, attached to the edge of tricuspid valve's septal leaflet by a stalk. The mass was excised and histological evaluation revealed myxoma. It is accepted that myxomas can develop after cardiac trauma. It is known that RFA for AF increases the risk of thrombus or endocarditis in the atrium. Herein, we report a myxoma case where we think the heat energy caused by RFA might have triggered the development of the tumor.     

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.     

Second recurrence of cardiac myxoma 7 years after the initial operation

We report a rare case of a 23-year-old woman in who recurrent multiple cardiac myxomas were resected first time 4 years after the initial operation and second time three years after the second operation. In February 2000, she was diagnosed with right ventricular myxoma. The initial cardiac tumor was successfully resected through a right atrium approach and the tricuspid valve was changed with a biological prosthesis; the patient has been followed-up by ultrasound echocardiography every 6-month after discharge. Four years after, the echocardiography revealed one masse in the left atrium, which was resected using a trans-septal approach. Due to malfunction of the tricuspid prosthesis, this was changed with a biological one. After another three years, the echocardiography revealed once again two masses, this time in the right atrium and left ventricle. The third surgery was performed and all 2 myxomas were successfully resected through a combined right atrial and left ventricle approach. One year after the third operation, she has been doing well without any sign of recurrence of myxoma. A long-term follow-up is mandatory in patients after the resection of a cardiac myxoma.     

Myxoma of the heart: clinical and experimental observations.

During the past 12 years, 13 patients with atrial (10 left and 3 right) myxoma have been treated. The tumors of the left atrium produced signs and symptoms of mitral valve obstruction and/or subacute bacterial endocarditis and those of the right atrium manifestations of tricuspid valve disease or of pulmonary embolus or hypertension. The diagnosis was established by angiocardiography in 8 patients, at surgery performed for suspected mitral stenosis in 3 patients, and at autopsy in 2 patients. Resection of the atrial myxoma alone in 5 patients or with atrial septum where the atrial myxoma was attached in 4 or with the whole right atrial wall where the atrial myxoma was attached in one patient was performed and all are doing well without evidence of recurrence. Studies of experimentally produced 1.5-3 cm in diameter left atrial thrombus in 30 dogs divided into 5 groups and followed cineangiocardiographically and sacrificed from 14 days to 6 months indicated that the implanted thrombus is absorbed over a 3 to 6 month period. These experimental and human left atrial thrombi were found to be histologically and histochemically different from human atrial myxomas. The electron microscopic studies performed on some of the resected atrial myxomas suggested that the atrial myxoma cells are active cells of endotheilial origin. These observations suggest that atrial myxoma is a primary tumor of the heart which can mimic other clinical entities, and the results of its surgical treatment are gratifying and long lasting.     

Obstructive neonatal atrial myxoma

IntroductionCardiac myxoma is a benign neoplasm representing the most common primary cardiac tumor in adults, however it is unusual in neonates. It is represented by an endocardial mass that occupies the cardiac chamber. Although the majority of myxomas are attached to the fossa ovalis of the interatrial septum, they also attach to the walls of the cardiac chambers and to valve leaflets surfaces. Approximately 75% of myxomas are found in the left atrium, 20% are located in the right atrium, and rarely in the ventricles.Presentation of caseWe describe a rare case of neonatal cardiac myxoma arising from interatrial septum, causing significant mechanical obstruction to blood flow through tricuspid valve, in an otherwise normal newborn. The patient underwent successful excision of the myxoma with an uneventful recovery [1].DiscussionCardiac tumors are rare in children, thus an understanding of the common types of benign and malignant paediatric cardiac tumors and their imaging features, is important because the epidemiology and tumor types differ from those encountered in adults.ConclusionLarge neonatal myxoma is exceptionally rare and even more infrequent is the surgical excision in the first day of life.     

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.     

Huge left atrial myxoma masking the severity of mitral regurgitation; report of a case

It is well known that mobile or large left atrial myxoma may lead to valve obstruction and insufficiency, and affect transmitral valve flow. A 50-year-old woman with a huge left atrial myxoma occluding the mitral valve was reported. The tumor was diagnosed by preoperative echocardiogram and mitral regurgitation was minimum. During the operation and after the myxoma resection, a severe mitral 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. Our case suggests that careful evaluation of mitral valve during a myxoma resection operation is recommended.     

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.     

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。