Bilateral myxoma presenting as multi-valvular heart disease

Excerpt

A 22-year-old lady presented with progressive exertional dyspnea. Her physical examination was suggestive of multi-valvular heart disease with predominant severe mitral stenosis. Further evaluation by transthoracic echocardiography revealed bilateral large atrial tumors attached to either side of the interatrial septum (Fig. 1A). The tumors were prolapsing through their respective atrioventricular valves, causing significant functional inflow obstruction (mean diastolic trans-mitral gradient of 12 mm of mercury) (as seen in Video 1). The atrioventricular valves were morphologically normal. Histopathological examination, done following resection of the tumors, confirmed the diagnosis of myxoma for both the masses (Fig. 1B). Hence, in patients with clinical features of multi-valvular heart disease, multiple myxomas should also be considered as an extremely rare possibility. Bilateral atrial myxomas are seldom encountered, representing less than 2.5% of all myxoma cases [1].

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