Non-Obstructive Accessory Mitral Valve Tissue in an Asymptomatic Adult: A Case Report and Review of Literature

Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly that is often an asymptomatic incidental finding. However, it has also been reported to be an important cause of left ventricular outflow tract obstruction (LVOTO) in subset of patients. When symptomatic, patients can often present with symptoms, including dyspnea, chest pain and palpitations/arrhythmias. Surgical resection is indicated in symptomatic cases with significant LVOTO. We here report a 50-year-old male who presented with chest pain and was incidentally found to have AMVT on an echocardiogram. No evidence of LVOTO was seen at rest, Valsalva, or stress. We also provide a review of literature in regards to most relevant clinical implication of AMVT

A Case of Double Orifice Mitral Valve in a Patient with Bicuspid Aortic Valve: Coincidental or a Missed Finding?

A 63-year-old male with past medical history of bicuspid aortic valve and ascending aortic aneurysm was referred to cardiology for aortic valve replacement (AVR) and aneurysm repair. Transthoracic echocardiogram (TTE) showed bicuspid aortic valve with severe aortic valve stenosis. Patient underwent transesophageal echocardiogram which showed an incidental finding of double orifice mitral valve (DOMV) with fusion of A/P cusps along anterolateral commissure not noted on previous TTE. Patient underwent AVR with bioprosthetic aortic valve along with resection and replacement of the ascending aortic aneurysm. No intervention was performed for the asymptomatic DOMV. DOMV is a rare congenital cardiac abnormality, easily missed on routine TTE. It warrants need for careful evaluation of mitral valve apparatus in patients with other congenital cardiac abnormalities known to be associated with DOMV

Sporadic Form of Recurrent Atrial Myxoma: The Blob Strikes Back

Cardiac myxoma is a benign neoplasm composed of stellate to plump, cytologically bland mesenchymal cells set in a myxoid stroma. Although benign, as they can lead to severe complications, they are often removed surgically. A 39-year-old female presented with a chief complaint of generalized fatigue. Patient had a history of a large 7cm x 2.5cm left atrial myxoma resected at the age of 32 years after she presented with symptoms of dyspnea on exertion. The dyspnea was due to prolapse of the mass through the mitral valve during diastole, leading to functional severe mitral stenosis. The mass was resected with clear margins confirmed on biopsy. On physical examination, heart rate was regular with no murmurs. No signs of congestive heart failure were noted. A 2D echo revealed a mobile structure in the left atrium along with mild mitral regurgitation. Cardiac MRI showed a 21mm x 9mm well defined, pedunculated, mobile mass in the left atrium arising from inter-atrial septum. The mass was hyperintense on T2 weighted images with patchy delayed hyper-enhancement consistent with recurrence of a myxoma. The patient underwent a repeat median sternotomy with the removal of left atrial mass and repair of atrial septum with hemashield patch. The mass was sent for pathological evaluation confirming the diagnosis of recurrent myxoma. On genetic testing, patient tested negative for mutations in PRKAR1A gene (mutated in up to 60%-80% cases with Carney complex), MEN1, RET and sarcoma (TP53) genes. Cardiac myxomas are rare primary benign tumors of the heart with a small recurrence rate. Follow-up studies have rarely reported recurrences after complete resection. However, in our case not only did the patient have the sporadic form of myxoma with recurrence, but it also occurred within three years of the previous resection despite complete removal with clear margins