Role of Transesophageal Echocardiography in the Recurrent Biatrial Myxoma of Uncommon Origin

After surgical excision of myxoma recurrence usually happens adjacent to the initial origin site. We report a case of recurrent myxomas in a young male patient that had biatrial recurrence with one tumor originating very unusually from the base of the anterior mitral leaflet. Intraoperative transesophageal echocardiography was instrumental in localizing the site of the origin of left atrial myxoma from the base of the anterior mitral leaflet and in detecting an additional myxoma attached to the wall of the right atrium.

A Case of Aortic Valve Endocarditis Complicated with an Aneurysm and Perforation of Anterior Mitral Leaflet

Aortic valve is usually involved in infective endocarditis. Aortic valve endocarditis produces destruction and perforation of leaflets and results in ring abscess, frequently. Less commonly, direct extension or infected aortic regurgitant jet can produce secondary involvement of anterior mitral leaflet (AML) and result in the formation of an aneurysm or perforation of AML. A 60-year-old woman was admitted to Kyung Hee University hospital because of a febrile illness and dyspnea. Transthoracic echocardiography (TTE) showed an aortic valve vegetation, an aneurysm of AML, and an eccentric jet of mitral regurgitation through AML. Transe-sophageal echocardiography (TEE) showed a perforation of AML. -streptococcus was isolated from blood culture. The patient was treated with Vancomycin and Sisomicin sulfate. On hospital day 21, heart failure was aggravated and emergent double valve replacement was done. The patient was recovered and discharged.

Reverse Doming of Anterior Mitral Leaflet in Aortic Regurgitation

In 40 patients with aortic regurgitation(AR), the incidence of reverse doming of anterior mitral leaflet was studied by 2-D echocardiography. Reverse doming could be indentified in 17 of 18 patients(94.4%)with severe AR, in 6 of 15 patients(14.3%)with mild AR. And in relation to the direction of regurgitant jet, reverse doming was noticed in 9 of 11 patients(82%) toward the center of left ventricular cavity. In conclusion, the appearance of reverse doming of anterior mitral leaflet is thought to be related to the degree of AR and the direction of regurgitant jet. And reverse doming by 2-D echocardiography is a helpful parameter for the diagnosis of moderate to severe AR.