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J Thorac Cardiovasc Surg 1995;109:1249-1250
© 1995 Mosby, Inc.

BRIEF COMMUNICATIONS

Right atrial myxoma originating from the tricuspid valve

Hiroaki Kuroda, MD, Kazutoyo Nitta, MD, Yasushi Ashida, MD, Yohichi Hara, MD, Shingo Ishiguro, MD, Tohru Mori, MD


Yonago, Japan

From the Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Myxoma arising from the heart valve is rare. We report here an unusual case of myxoma attached to the tricuspid leaflet, which was successfully treated by partial excision of the leaflet.

A 71-year-old man was admitted with a 1-year history of exertional dyspnea. The electrocardiogram showed atrial flutter and incomplete right bundle branch block, and the chest x-ray film showed mild cardiomegaly. Transthoracic and transesophageal echocardiograms showed a 5 by 4 cm mass in the right atrium originating from the lower interatrial septum, and prolapsing into the right ventricle through the tricuspid orifice during diastole (Fig. 1). A coronary angiogram showed 75 stenosis of right coronary artery (RCA) and the small feeding artery from the RCA.




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  		Fig. 1. Two-dimensional echocardiogram shows right atrial mass prolapsing into right ventricle during diastole. RV, Right ventricle; TV, tricuspid valve; AO, aorta; LA, left atrium; RA, right atrium.

 
The patient underwent operation with the aid of cardiopulmonary bypass. The right atrium contained the giant tumor, which was attached to the septal leaflet of the tricuspid valve close to the anulus. The mass was removed with excision of a small ellipse (about 5 mm) of valve leaflet at the base. The leaflet was reapproximated. Coronary artery bypass grafting to the RCA with a saphenous vein graft was added. The patient was weaned from bypass without difficulty, and an intraoperative transesophageal echocardiogram showed no evidence of tricuspid regurgitation. Recovery from the operation was uneventful. A postoperative pulmonary perfusion scintiscan showed no defect. The tumor was rigid, 7 by 5 by 4 cm in size, and 62 gm in weight. The histologic diagnosis was confirmed to be myxoma, and there were no tumor cells in the excised leaflet.

Primary cardiac valve tumors are uncommon, with an incidence of less than 10% of all cardiac tumors. In a recent review, Go 1 56 valve tumors occurring in 53 patients over a 58-year period were documented. Forty-one of these tumors (73%) were fibroelastomas, and five of them (8.9%) were myxomas. Although myxoma can occur on the tricuspid valve, Go Go 2,3 mitral valve, Go Go 1,4 and pulmonary valve, Go 5 it appears that valvular involvement is more common on the right side than on the left side. Cole and associates Go 2 summarized the 11 tricuspid valve myxomas. Five of them had tumor attachment on the atrial side of the valves like our case. There seem to be no distinct clinical features that would lead to the diagnosis of involvement of the tricuspid valve. Before the advent of echocardiography, diagnoses of valve tumor were difficult and often made at autopsy. The reports of this rare condition will certainly increase with more cases of even small tumors being referred for evaluation after echocardiographic identification. Valve tumors should be managed surgically by complete excision to avoid recurrence of the tumor. In our patient, the location of the tumor on a septal leaflet of the tricuspid valve and its small attachment made conservation of the valve possible.

Footnotes

J THORAC CARDIOVASC SURG 1995;109:1249-50 Back

References

  1. Edwards FH, Hale D, Cohen A, Thompson L, Pezzella T, Virmani R. Primary cardiac valve tumors. Ann Thorac Surg 1991;52:1127-31.[Abstract]
  2. Cole DJ, Hendren WG, Sink JD, D'Amato PH. Myxoma attached solely to the tricuspid valve. Am J Cardiol 1989;64:546-7.[Medline]
  3. Suri RK, Pattankar VL, Singh H, Aikat BK, Gujral JS. Myxoma of the tricuspid valve. Aust N Z J Surg 1978;43:429-32.
  4. Sandrasgra FA, Oliver WA, English TAH. Myxoma of the mitral valve. Br Heart J 1979;42:221-3.[Abstract/Free Full Text]
  5. Catton RW, Guntheroth WG, Reichenbach DD. A myxoma of the pulmonary valve causing severe stenosis in infancy. Am Heart J 1963;66:248-52.[Medline]




This Article
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