A 16-year-old boy presented with fever, myalgia, and pain and swellings of fingers and toes. Osler's nodes and Janeway lesions were found on the palms and soles (Figure 1). Laboratory findings showed a leukocytosis and high C-reactive protein, but a negative blood culture. Echocardiography showed a huge, irregular shaped, mobile mass in the left ventricular outflow track (LVOT), attached to the anterior leaflet of mitral valve (MV) and protruded into LVOT during systole (Figure 2, and Supplementary Videos 1, 2, 3, 4). Brain magnetic resonance imaging and abdominal computed tomography showed multiple embolic infarctions in the brain, spleen, and kidneys (Figure 3). Immediate surgical excision with MV preservation was performed (Supplementary Video 5), showing a large, friable, and polypoid mass (Figure 4A). Histology confirmed MV myxoma (Figure 5). Fever subsided on the next day. The patient was discharged home 9 days after operation. One month later, fever, and hands and feet pains redeveloped. Echocardiography showed a recurrent myxoma at the anterior leaflet of MV (Figure 6, and Supplementary Videos 6 and 7). New acute embolic infarctions in the brain and spleen were also found. MV replacement was done after en bloc excision of the tumor and MV anterior leaflet (Figure 4B).
Most cardiac myxoma arises from the left atrium, while MV myxomas are very rare and mostly from atrial side of MV.1)2) As our case, a huge myxoma originated from ventricular side of anterior MV has not been reported in children.3) In addition, tumor recurrence within a month is very unusual, which usually takes more than several months or years.4)
The Institutional Review Board of Seoul Saint Mary's Hospital approved this study and the patient's informed consent was waived (IRB number: KC21ZISI0322).
Notes
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
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