CLINICAL PRESENTATION AND TREATMENT OPTIONS FOR MITRAL-VALVE MYXOMA

Myxomas rarely are located on the mitral valve. We report the case of a 44-year-old man operated on successfully with mitral valve conservat ion, which is the 21st cafe of mitral valve myxoma reported in the wes tern literature. Among the cases reported in the literature, the diagn osis was made at the time of autopsy in 6 cases, with premortem heart failure in 1 case. A clinical diagnosis was made in 15 cases on the ba sis of the following symptoms: peripheral embolism in 9 cases, cardiac signs in 4 cases, and constitutional manifestations in 2 cases. The c linical presentation of mitral valve myxoma differs slightly from that of other cardiac myxomas in that it has a lower incidence of constitu tional manifestations. The gold standard for noninvasive diagnosis and localization of cardiac myxomas is transesophageal echocardiography. It allows for the detection of early, small valvular tumors and may he lp to characterize better their location and echostructure, facilitati ng the choice of an optimal surgical approach through preoperative stu dy of the integrity and mobility of the valve. Conservative operative treatment by resection of the area of implantation of the myxoma follo wed by suture repair of the valve and annuloplasty may be recommended as the most appropriate treatment option for this rare condition. (C) 1997 by The Society of Thoracic Surgeons.