Preoperative assessment of mitral valve abnormalities in left atrial myxoma patients using cardiac CT

Abstract

BackgroundTo retrospectively evaluate mitral valve abnormality in left atrial myxoma patients by using cardiac computed tomography (CT).Material and methodsCardiac CT was performed in 56 patients with left atrial myxoma and 50 controls. Tumor and mitral valve characteristics were analyzed. The mitral valve parameters differences were compared between patients with myxoma and controls, myxoma with or without mitral valve obstruction, different obstruction degrees, respectively. Receiver operating characteristic analysis was performed to determine the cut-off values of abnormal mitral valve parameters for myxoma patients. Multiple linear regression, logistic regression models and cox regression analysis were used to determine factors associated with mitral valve abnormalities, mitral obstruction, mitral regurgitation and postoperative recovery, respectively.ResultsMyxoma induced the dilation of mitral valve, with different results among different degrees of obstruction (p<0.001). Mitral valve parameters had relationship with myxoma parameters. The cut-off values for discriminating mitral valve abnormalities in myxoma patients were found. Some significant predictors for mitral obstruction were tumor pedicle-tumor volume and patient age (HR, 0.886-30.811; p = 0.011-0.043). Moreover, the predictor for mitral regurgitation was mitral annulus diameter in diastolic phase (HR, 20.862; 95%CI,1.331-327.100; p = 0.031). Some predictors associated with postoperative recovery of mitral regurgitation were age, mitral annulus area, mitral annulus diameter and mitral valve diameter cutoff value for diastolic phase (HR, 0.001-119.160; p = 0.012-0.028).ConclusionCardiac CT is capable of quantitatively assessing myxoma characteristic and mitral valve abnormality induced by myxoma, thus providing guidance of operative management and postoperative evaluation.

Unusual cause of heart failure in the young, the intracardiac mass: Diagnostic dilemmas solved by echocardiography

“…In contrary, most of the MR cases remained complicated with regurgitation post-operatively even with additional mitral valve repair or replacement procedure. 14,15 Our patient recovered substantially post-operative with residual MR without any further mitral intervention intra-operatively.…”

“…Valvular regurgitation and cardiac arrhythmias remain as the most common post-operative complication, followed by delayed sternal wound healing, rarely pericardial effusion and pneumothorax. 2,14 Pre-operatively, left-sided cardiac myxoma commonly causes mitral stenosis (66.1%) by obstructing the outflow tract followed by mitral regurgitation (33.9%), postulated to be caused by the dilation of the mitral annulus. All cases with mitral stenosis recovered post-excision of myxoma.…”

Myriad manifestations of myxoma

“…More interestingly, preoperative imaging studies have shown that the mitral annulus may be enlarged in some patients with myxoma. 3 This may result either from mechanical stretching of the valve and annulus by tumor protrusion or as a compensatory change to increase effective valve orifice to accommodate blood flow across the mitral valve obstructed by the tumor. In this issue of the Journal, Blanco and colleagues 4 elegantly report another interesting mechanism of mitral regurgitation.…”