Baek Seung-Hoon, Kim Hee Young, Kim Hyae Jin, Shin Sang Wook, Kim Hye Jin, Choi Yun Mi, Choi Eun Ji, Chang Eunjung, Son Hong-Sik
Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Busan, Korea.
J Thorac Dis. 2017 Mar;9(3):E258-E263. doi: 10.21037/jtd.2017.03.45.
We report obstruction of the left ventricle outflow tract (LVOT) caused by cardiac myxoma that was misidentified as an accessory mitral valve tissue preoperatively. A 65-year-old woman presented with chest discomfort that persisted for 7 days. Transthoracic echocardiography (TTE) revealed a mobile, low-echogenic, balloon-shaped mass attached to the anterior mitral valve leaflet and papillary muscle, which was suspected to be an accessory mitral valve tissue. Because the mass caused LVOT obstruction and it could result in hemodynamic instability, emergency operation was performed. Intraoperative transesophageal echocardiography (TEE) was performed, and the mass had irregular margins and was pedunculated, with a stalk originating from the left ventricle (LV) wall and extending to the lateral chordae of the mitral valve. The surgeon excised the mass filled with the myxomatous mass, which was yellowish and gelatinous and had a stiff stalk, and histopathologic diagnosis confirmed a myxoma. Although mitral valve or LV myxomas are rare, TEE is a useful tool for distinguishing a myxoma from other intracardiac masses, such as vegetation or an accessory mitral valve tissue.
我们报告了一例因心脏黏液瘤导致左心室流出道（LVOT）梗阻的病例，该黏液瘤在术前被误诊为二尖瓣附属组织。一名65岁女性出现持续7天的胸部不适。经胸超声心动图（TTE）显示一个活动的、低回声、气球样肿物附着于二尖瓣前叶和乳头肌，怀疑是二尖瓣附属组织。由于该肿物导致LVOT梗阻并可能导致血流动力学不稳定，遂进行了急诊手术。术中进行了经食管超声心动图（TEE）检查，肿物边缘不规则且有蒂，蒂起源于左心室（LV）壁并延伸至二尖瓣外侧腱索。外科医生切除了充满黏液瘤样肿物的肿块，该肿物呈淡黄色、胶冻样，有一个硬蒂，组织病理学诊断证实为黏液瘤。尽管二尖瓣或LV黏液瘤罕见，但TEE是区分黏液瘤与其他心内肿物（如赘生物或二尖瓣附属组织）的有用工具。
