Full text of DOI:10.1177/021849230201000220

Intramural Cardiac Myxoma
CASE STUDY
Rendón
Intramural Cardiac Myxoma in
Left Ventricular Wall:
an Unusual Location
SPAIN
Felipe Rendón, MD, Julio Agosti, MD,
Alberto Llorente, MD, David Rodrigo, MD1,
Kepa Montes, MD1
Division of Cardiac Surgery
1Division of Cardiology
Hospital de Cruces
Barakaldo, Spain
ABSTRACT
A 27-year-old asymptomatic woman was investigated for an abnormal finding in
the cardiac contour on routine chest radiography. Echocardiography revealed a
heterogeneous mass in the anterolateral left ventricular wall. Excision of the tumor
disclosed an absence of communication between the residual cavity and the left
ventricular endocardium. Histological features of the tumor indicated an intramural
myxoma.
(Asian Cardiovasc Thorac Ann 2002;10:170–2)
INTRODUCTION
distortion of the left anterior descending artery and
abnormal vascularity in the area between this artery and
the first diagonal branch. The patient underwent surgery
via a median sternotomy. After pericardiotomy, a
prominent soft mass was detected bulging over the LV
wall in the area between the left anterior descending
artery and the first diagonal branch. Puncturing this area
led to drainage of a clear yellow viscous liquid. Cardio-
pulmonary bypass was established under moderate
systemic hypothermia and cold blood cardioplegia. A
vertical left ventriculotomy revealed a large tumor
(6 × 4 × 3.5 cm) that was not encapsulated, yellow-white
in color, and of gelatinous appearance, consisting of
multiple friable polypoid fronds. Excision of the tumor
disclosed an absence of communication between the
residual cavity and the LV endocardium. The defect was
closed in a linear fashion and reinforced with felt strips
Cardiac tumors are quite rare and the majority are
myxomas.1 Most cardiac myxomas are found in the left
(75%) or right atria (20%) and in rare cases, they are
found in the ventricles, but always intracavitary.2 This
report describes an intramural cardiac myxoma in the left
ventricular (LV) wall, a location not previously reported.
CASE REPORT
A 27-year-old white female was referred to our unit
because of an abnormal finding in the cardiac contour on
routine chest radiography. She reported no symptoms and
lead an active life. Clinical examination was normal.
Electrocardiography showed sinus rhythm, negative T
waves in leads V1 to V5, and signs of LV hypertrophy.
Chest radiography revealed cardiomegaly, rectification
of the left border of the heart, and normal lung fields
(Figure l). Echocardiography disclosed a heterogeneous in the usual manner. The postoperative course was un-
mass in the anterolateral LV wall, and no other findings eventful and the patient was discharged in good condition.
(Figure 2). Magnetic resonance imaging indicated a tumor
Histologic analysis of the tumor revealed a myxoid matrix
without fibers, within which were embedded stellate,
fusiform, and polygonal cells with scant eosinophilic
measuring approximately 5.6 × 3.6-cm in the LV wall,
which was not obstructing the LV outflow tract (Figure 3).
Coronary angiography (Figure 4) was normal except for
For reprint information contact:
Felipe Rendón, MD Tel: 52 81 8348 8305 Fax: 52 81 8333 9077 email: drfrendon@yahoo.com.mx
Division of Cardiac and Thoracic Surgery, “Jose E. Gonzalez” University Hospital, Madero y Gonzalitos S/N 1st Floor,
Monterrey, Nuevo León, CP 64460, Mexico.
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Rendón
Intramural Cardiac Myxoma
A
Figure 1. Posteroanterior chest radiograph demonstrating rectification
of the left border and cardiac enlargement.
B
Figure 3. (A) Coronal magnetic resonance image revealing a tumor
with a heterogeneous appearance: peripheral high signal and central low
signal intensity (this finding represents the myxomatous component).
(B) Axial magnetic resonance image showing a tumor occupying the
left ventricular wall.
Figure 2. Long-axis transthoracic echocardiogram showing a
heterogeneous echogenic left ventricular mass.
cytoplasm and no mitotic activity. These cells were
arranged singly and in small nests. Other cells with a
vascular appearance were also seen. The endocardial layer
under the tumor had a normal appearance. Based on these
histological features, the tumor was considered to be an
intramyocardial myxoma.
DISCUSSION
Cardiac myxoma is a benign neoplasm of endocardial
origin. It affects patients aged 11 to 82 years (mean age,
50 years) and it has a female predominance. The tumor
usually projects from the endocardium into the cardiac
chamber. The cells giving rise to these tumors are
considered to be multipotential mesenchymal cells that
persist as embryonal residues during septation of the
heart; thus the prevalence of myxomas in the atrial septum
is understandable.3 Two distinct types of cardiac myxomas
have been described: sporadic myxomas occur mostly in
the left atrium (86%) and have a typical presentation;
Figure 4. Cineangiogram (left anterior oblique view) disclosing distortion
of the left anterior descending artery and abnormal vascularity in the area
between left anterior descending artery and the first diagonal branch.
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Intramural Cardiac Myxoma
Rendón
familial myxomas constitute 7% of cardiac myxomas and Cardiac myxomas continue to generate interest because
exhibit atypical biological behavior including multicen- of their uncertain histogenesis. The intramural cardiac
myxoma in the left ventricle wall in our patient supports
the hypothesis that the stromal cells of cardiac myxoma
derive from multipotential mesenchymal cells.8 This case
also serves to remind that in a young patient with
alterations in the ST segment and no cardiac risk factors,
one must rule out a cardiac tumor.
tricity (45%), atypical location (in cardiac chambers other
than the left atrium, 38%), recurrence after surgical
excision (12% to 22%), and unusual associated conditions
(20%) such as the Carney complex.4 Patients with a
familial predisposition to cardiac myxoma are usually
younger (mean age, 28 years) and they have less female
predominance. How fast cardiac myxomas grow has never
been clarified, but it appears they might grow rather
rapidly (average rate of 0.15 cm per month).5
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