Myxoma of the Left VentricleThis report concerns a 69-year-old
Case ReportA 69-year-old woman with known chronic liver disease was admitted for acute liver dysfunction in association with nonspecific autoimmune disease, rheumatoid arthritis, hypothyroidism, and arterial hypertension. She reported no cardiac diseases or chest pain. During her hospitalization, transthoracic and transesophageal echocardiograms showed a single pediculated round mass (13 × 23 mm) attached to the left ventricular endocardium (Figs. 1 and 2). Chest radiographs, the electrocardiogram, and standard blood tests all showed normal findings. The patient's body mass index was 26.24 kg/ m 2 . A liver function test yielded normal results except for a moderate increase of serum glutamic-oxaloacetic transaminase (93 U/L) and serum glutamic-pyruvic transaminase (92 U/L), as determined by enzymatic and colorimetric spectrophotometry.The patient underwent excision of the intracardiac mass on 5 May 2010, under general anesthesia. A median sternotomy was performed. The ascending aorta and both venae cavae were cannulated, and standard cardiopulmonary bypass (CPB) was performed. The heart was stopped by cross-clamping the ascending aorta. Myocardial protection was achieved by means of topical cooling with ice and intermittent anterograde and retrograde administration of cold-blood cardioplegic solution. The venae cavae were snared with tourniquets, the tumor was excised through a limited left ventriculotomy, and the tumor's pedicle was shaved from the endocardium. The incision was closed with a double layer of 3-0 polypropylene running suture (Fig. 3). The patient was weaned from CPB easily, without inotropic support. Under histopathologic examination, the excised mass was consistent with myxoma. A follow-up echocardiogram 3 months postoperatively disclosed no abnormalities. The patient was lost to follow-up.
DiscussionThe first reported case of surgical removal of a left ventricular myxoma was that published by Kay and colleagues in 1959.1 Since then, at least 71 other surgical cases (excluding myxomas of the mitral or aortic valve) have been reported, most of them as single cases (Table I). Most medical centers have little or no experience in the management of a myxoma in the left ventricle. The surgical approach to a tumor in this location can be carried out 1) through the left atrium and mitral valve, 2) through the ascending aorta, with video assistance, 3) through the right atrium and atrial septum, or 4) through a small longitudinal incision in the left ventricle. We decided on this last approach because it affords good visibility and the possibility of a complete resection. Most reported excisions of left ventricular myxoma have been performed with use of full median sternotomy and classical CPB. Recently, endoscopy and minimally invasive techniques have also been applied.
