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The TEE showed a mass in the LVOT that appeared to be attached to the anterior mitral valve.
Specifically, the mass appeared to be attached near A3.
The LVEF was 50%.
The wall motion was normal.
There was mild aortic insufficiency.
There was minimal turbulence in the LVOT.
The AR jet appeared to be directed towards the mass.
The aortic valve had Lambl's Excressences
Tumors of the heart are separated into different classifications:
Benign tumors occur in 80% of the tumors of the heart and are:
Papillary Fibroelastoma 10%
Mesothelioma of the AV Node 1%
Cysts can also occur in the following incidence:
Pericardial Cyst 18%
Bronchogenic Cyst 2%
The most common benign tumor is a myxoma. Myxomas typically occur upstream side of the valve.
Myxomas can be large, have a ground-glass consistency, are irregular, mobile, have a stalk (some are very long or very short), and are pliable.
Myxomas can exhibit emboli phenomena or cause obstructive symptoms (syncope).
Myxomas can also be part of the Carney Complex:
Mutiple lentigines and blue nevi
Peripheral myxoid tumors
Psamommatous melanotic schwannoma
Endocrine over activity
Testicular Sertoli cell tumors
Multiple Recurrent Cardiac Masses
The Carney Complex is familial/autosomal dominant.
Fibroelastomas are the second most common tumor and typically occurs on the downstream side of a valve. Fibroelastomas arise from valvular
tissue and are histologically similar to Lambl's Excressence. Fibroelastomas are usually small, and mobile. A fibroelastoma usually appears as a
cauliflower or frond-like tumor. On echocardiography it appears to be similar to a sea anemone. Fibroelastomas can have pieces break off and embolize or
the whole tumor can embolize. Fibroelastomas can be confused with vegetations. Vegetations are usually on the upstream side of a valve.
Lipomatous hypertrophy of the atrial septum can occur. Usually the superior and inferior portions of the septum have lipomatous deposition and
the fossa ovalis is spared making the atrial septum appear as a bow-tie. Occasionally the fossa ovalis exhibits rings of limpoatous depostions.
Malignant tumors of the heart comprise 20% of the cardiac tumors. Local invasion or metastastic tumors are:
Primary cardiac malignancies are:
Malignant Lymphoma 2%
Extraskeletal Osteosarcoma 1%
Other tumors invade the heart via the venous system are are:
Renal Cell Carcinoma
Lastly, tumors can affect the heart by production of neuroendocrine substances such as:
For this case, while the pathology came back as a fibroelastoma the intraoperative image if the tumor did not have the typical
fond-like appearance of a fibroelastoma.
Braunwald's Heat Disease
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