Conservative surgery for atrioventricular valve myxoma

Patients with valvular myxoma are usually candidates for surgery because of the high incidence of life-threatening embolism. In some cases, the tumor is sessile or presents with a large peduncle: complete excision may then le ad to valve replacement. We report two cases of atrioventricular valve myxo ma where replacement was avoided. In one patient, a mitral myxoma appended from the edge of the anterior leaflet close to the chordae insertion; safe excision implied destruction of the two chordae and a peritumoral section o f the anterior leaflet. A chordal transposition technique Was used to prese rve valve competence. In a second patient, a tricuspid myxoma causing synco pal episodes was resected; this was characterized by a large stalk, located on the anterior tricuspid leaflet away from chordal attachment and the val vular annulus. Treatment was by resection and the leaflet reconstructed wit h a pericardial patch. Techniques for conservative treatment of degenerativ e valvular disease or endocarditis, when monitored peroperatively by transe sophageal echocardiography may be successful in the surgical resection of a trioventricular myxoma.